Provider Demographics
NPI:1649362385
Name:WOOLSEY, MARY LORD (PH D)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LORD
Last Name:WOOLSEY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 EAST WASHINGTON STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-3928
Mailing Address - Country:US
Mailing Address - Phone:319-354-3232
Mailing Address - Fax:319-354-2990
Practice Address - Street 1:209 EAST WASHINGTON STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-3928
Practice Address - Country:US
Practice Address - Phone:319-354-3232
Practice Address - Fax:319-354-2990
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00850103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA49617OtherBCBS IA
IA49617OtherBCBS IA