Provider Demographics
NPI:1730249293
Name:LENNON, MARY M (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:LENNON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 EAST PUTNAM AVE
Mailing Address - Street 2:2ND FL W
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807
Mailing Address - Country:US
Mailing Address - Phone:203-629-0910
Mailing Address - Fax:203-778-4040
Practice Address - Street 1:126 EAST PUTNAM AVE
Practice Address - Street 2:2ND FL W
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807
Practice Address - Country:US
Practice Address - Phone:203-629-0910
Practice Address - Fax:203-778-4040
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001397101YM0800X
NY0011811101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health