Provider Demographics
NPI:1194079269
Name:EATON, MARY D (MSED)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:D
Last Name:EATON
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:D
Other - Last Name:FARINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:1 RAPP ROAD
Mailing Address - Street 2:ADVANCED THERAPY, PLLC
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-867-3062
Mailing Address - Fax:518-867-3066
Practice Address - Street 1:1 RAPP ROAD
Practice Address - Street 2:ADVANCED THERAPY P.L.L.C.
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-867-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY363207911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist