Provider Demographics
NPI:1831993450
Name:MARY J BELONGEA
Entity type:Organization
Organization Name:MARY J BELONGEA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIMITED LICENSE PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BELONGEA
Authorized Official - Suffix:
Authorized Official - Credentials:LIMITED LICENSE PSYC
Authorized Official - Phone:734-417-8438
Mailing Address - Street 1:657 WATERSEDGE DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2514
Mailing Address - Country:US
Mailing Address - Phone:734-417-8438
Mailing Address - Fax:
Practice Address - Street 1:657 WATERSEDGE DR
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2514
Practice Address - Country:US
Practice Address - Phone:734-417-8438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty