Provider Demographics
NPI:1285055335
Name:EPPS, MARY (CADC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:EPPS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19132-4013
Mailing Address - Country:US
Mailing Address - Phone:215-599-8914
Mailing Address - Fax:215-226-1278
Practice Address - Street 1:2514 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19132-4013
Practice Address - Country:US
Practice Address - Phone:215-599-8914
Practice Address - Fax:215-226-1278
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA555666111101YM0800X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA555666111Medicare PIN