Provider Demographics
NPI:1205139714
Name:FEGURGUR, MARY (PSYD, LCSW)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:FEGURGUR
Suffix:
Gender:F
Credentials:PSYD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 326598
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GUAM
Mailing Address - Zip Code:96932
Mailing Address - Country:DE
Mailing Address - Phone:671-483-4278
Mailing Address - Fax:
Practice Address - Street 1:426 CHALAN SAN ANTONIO STE 104
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3631
Practice Address - Country:US
Practice Address - Phone:671-649-5910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS187801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical