| Mary Mirro, Psy. D., Hspp, Llc | |
|
1024 Sterling Ct Crown Point IN 46307-2686 | |
| (219) 805-7407 | |
| Not Available |
| Full Name | Mary Mirro, Psy. D., Hspp, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 1024 Sterling Ct, Crown Point, Indiana |
| Authorized Official Name and Position | Mary Mirro (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 2198057407 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Mirro, Psy. D., Hspp, Llc 1024 Sterling Ct Crown Point IN 46307-2686 Ph: (219) 805-7407 | Mary Mirro, Psy. D., Hspp, Llc 1024 Sterling Ct Crown Point IN 46307-2686 Ph: (219) 805-7407 |
| NPI Number | 1114059953 |
|---|---|
| Provider Enumeration Date | 03/09/2007 |
| Last Update Date | 12/21/2022 |
| Certification Date | 12/21/2022 |
| Medicare PECOS PAC ID | 7012009376 |
|---|---|
| Medicare Enrollment ID | O20070816000726 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114059953 | NPI | - | NPPES |
| 200529940 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 20041970A (Indiana) | Primary |
| Provider Name | Mary A Mirro |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1407857972 PECOS PAC ID: 8325024086 Enrollment ID: I20050926000946 |
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