Provider Demographics
NPI:1124174073
Name:PRUNEAU, MARY M (PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:PRUNEAU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 NORMANDY RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-5210
Mailing Address - Country:US
Mailing Address - Phone:586-263-2760
Mailing Address - Fax:586-263-2762
Practice Address - Street 1:43411 GARFIELD RD STE A
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-1152
Practice Address - Country:US
Practice Address - Phone:586-263-2760
Practice Address - Fax:586-263-2762
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist