Provider Demographics
NPI:1356603328
Name:FEENEY, MARY ALICE (MS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALICE
Last Name:FEENEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HALF MOON DR
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:NY
Mailing Address - Zip Code:12413-2513
Mailing Address - Country:US
Mailing Address - Phone:518-622-0433
Mailing Address - Fax:
Practice Address - Street 1:2395 ROUTE 23B
Practice Address - Street 2:
Practice Address - City:SOUTH CAIRO
Practice Address - State:NY
Practice Address - Zip Code:12482-1220
Practice Address - Country:US
Practice Address - Phone:518-622-8382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033272001174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist