Provider Demographics
NPI:1700325214
Name:M. WHARRY, INC.
Entity Type:Organization
Organization Name:M. WHARRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WHARRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:386-804-6074
Mailing Address - Street 1:102 CEDAR POINT LN
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4944
Mailing Address - Country:US
Mailing Address - Phone:386-804-6074
Mailing Address - Fax:
Practice Address - Street 1:101 N WOODLAND BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-4245
Practice Address - Country:US
Practice Address - Phone:386-804-6074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9476103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty