Doctor Name: | MS. MARY KAY BOOTH |
NPI Number: | 1801937826 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BA, CASAC, LMHC |
License Number: | 001771 |
Business Practice Address: | 95 E Main St Allegany, NY - 147061305 |
Business Phone Number: | 7163731330 |
Business Fax Number: | |
Mailing Address: | 109 N 9th St, OLEAN |
State: | NY |
Postal Code: | 147602209 |
Phone Number: | 7163738620 |
Fax Number: | |
NPI Enumeration Date: | 02/11/2007 |
NPI Last Update Date: | 05/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 001771 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |