Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 152 | AZ |
Y | 103T00000X | Psychologist | 152 | AZ |
N | 103TC1900X | Counseling Psychologist | 152 | AZ |
NPI | 1073993093 |
---|---|
Provider Name | Mary Baron |
First Address | Anthem, AZ 85086-0430 |
Second Address | Anthem, AZ 85086-0430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2015 |
Last Update Date | 04/06/2015 |