Provider Demographics
NPI:1043545510
Name:ANISE, MARY CHRISTINE (PSYD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHRISTINE
Last Name:ANISE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 WALNUT HILL LN
Mailing Address - Street 2:DEPARTMENT OF PSYCHIATRY
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4426
Mailing Address - Country:US
Mailing Address - Phone:214-345-7355
Mailing Address - Fax:214-345-8753
Practice Address - Street 1:8200 WALNUT HILL LN
Practice Address - Street 2:DEPARTMENT OF PSYCHIATRY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4426
Practice Address - Country:US
Practice Address - Phone:214-345-7355
Practice Address - Fax:214-345-8753
Is Sole Proprietor?:No
Enumeration Date:2009-10-16
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33198103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist