Provider Demographics
NPI:1699901694
Name:HEDGE, MARIE THERESE (BSC, MED)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:THERESE
Last Name:HEDGE
Suffix:
Gender:F
Credentials:BSC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 W SENECA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3342
Mailing Address - Country:US
Mailing Address - Phone:607-277-8020
Mailing Address - Fax:607-277-7961
Practice Address - Street 1:1001 W SENECA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3342
Practice Address - Country:US
Practice Address - Phone:607-277-8020
Practice Address - Fax:607-277-7961
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool