Individual
MARY MIRRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
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
103T00000X
Psychologist
Primary
20041970A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200529940
—
IN
Enumeration date
08/09/2005
Last updated
12/21/2022
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