Provider Demographics
NPI:1437237484
Name:HENNESSEY-PEIRCE, MARY MICHAELLE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHAELLE
Last Name:HENNESSEY-PEIRCE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:MICHAELLE
Other - Last Name:HENNESSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:975 E SCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-558-1065
Mailing Address - Fax:
Practice Address - Street 1:7254 E SOUTHERN AVE
Practice Address - Street 2:SUITE #123
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:602-617-6595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-11-12
Deactivation Date:2010-09-30
Deactivation Code:
Reactivation Date:2010-11-12
Provider Licenses
StateLicense IDTaxonomies
AZ0579101YA0400X
AZ103731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
551263OtherVALUE OPTIONS
551263OtherVALUE OPTIONS