Provider Demographics
NPI:1730157983
Name:MUNGER, MARY T (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:MUNGER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:T
Other - Last Name:MUNGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:300-C CODIFER BLVD.
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3777
Mailing Address - Country:US
Mailing Address - Phone:504-832-3066
Mailing Address - Fax:504-362-3711
Practice Address - Street 1:300 CODIFER BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3777
Practice Address - Country:US
Practice Address - Phone:504-832-3066
Practice Address - Fax:504-362-3711
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-12
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA521103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA6145701OtherUNITED BEHAVORAL HEALTH
LA048463000OtherMAGELLAN BEHAVIORAL HEALT
LA20545OtherBLUE CROSS/BLUE SHIELD
LA048463000OtherMAGELLAN BEHAVIORAL HEALT