Provider Demographics
NPI:1285728782
Name:HARAN, MARY (APRN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:HARAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 NORTH MAIN ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SOUTHINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06489
Mailing Address - Country:US
Mailing Address - Phone:860-628-9121
Mailing Address - Fax:860-276-8670
Practice Address - Street 1:51 NORTH MAIN ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489
Practice Address - Country:US
Practice Address - Phone:860-628-9121
Practice Address - Fax:860-276-8670
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0011102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry