Provider Demographics
NPI:1699716316
Name:POSNER, MARY E (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:POSNER
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 1:203 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1409
Mailing Address - Country:US
Mailing Address - Phone:812-649-9534
Mailing Address - Fax:812-649-9534
Practice Address - Street 1:203 ELM ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1409
Practice Address - Country:US
Practice Address - Phone:812-649-9534
Practice Address - Fax:812-649-9534
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100224940AMedicaid
IN750620Medicare ID - Type Unspecified