Provider Demographics
NPI:1811937717
Name:ANDERSON-WILEY, MARY JANE (PHD, LMHC)
Entity type:Individual
Prefix:DR
First Name:MARY JANE
Middle Name:
Last Name:ANDERSON-WILEY
Suffix:
Gender:F
Credentials:PHD, LMHC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LMHC
Mailing Address - Street 1:9 ROUNDHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532-3873
Mailing Address - Country:US
Mailing Address - Phone:706-627-7770
Mailing Address - Fax:508-213-3673
Practice Address - Street 1:349 OLD PLYMOUTH ROAD
Practice Address - Street 2:
Practice Address - City:SAGAMORE BEACH
Practice Address - State:MA
Practice Address - Zip Code:02562-2367
Practice Address - Country:US
Practice Address - Phone:706-627-7770
Practice Address - Fax:508-213-3673
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9038101Y00000X, 101YM0800X, 101YS0200X, 101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool