Provider Demographics
NPI:1780802132
Name:FOGARTY, MARYANN F (PHD)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:F
Last Name:FOGARTY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:F
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:5586 POST RD UNIT 205
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3454
Mailing Address - Country:US
Mailing Address - Phone:401-884-2733
Mailing Address - Fax:
Practice Address - Street 1:5586 POST RD UNIT 205
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3454
Practice Address - Country:US
Practice Address - Phone:401-884-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS00215103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist