Provider Demographics
NPI:1881952893
Name:REED, MARY ALICE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ALICE
Last Name:REED
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 SAINT JOE CENTER RD STE 42
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-5000
Mailing Address - Country:US
Mailing Address - Phone:260-267-0497
Mailing Address - Fax:260-960-9492
Practice Address - Street 1:1910 SAINT JOE CENTER RD STE 42
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-267-0497
Practice Address - Fax:260-960-9492
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN340010711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical