Provider Demographics
NPI:1134450323
Name:FEAKINS, MARY L (MA, LMFT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:FEAKINS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MANITOU RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6043
Mailing Address - Country:US
Mailing Address - Phone:203-246-7498
Mailing Address - Fax:
Practice Address - Street 1:27 MANITOU RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-6043
Practice Address - Country:US
Practice Address - Phone:203-246-7498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist