Organization
MARY MIRRO, PSY. D., HSPP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY MIRRO PSY D (PSYCHOLOGIST/OWNER)
(219) 805-7407
Entity
Organization
Contact information
Practice address
1024 STERLING CT, CROWN POINT, IN 46307-2686
(219) 805-7407
Mailing address
1024 STERLING CT, CROWN POINT, IN 46307-2686
(219) 805-7407
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041970A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200529940
—
IN
Enumeration date
03/09/2007
Last updated
12/21/2022
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