Provider Demographics
NPI:1487889606
Name:TIBBITS, MARY PIXLEY
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:PIXLEY
Last Name:TIBBITS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PIXLEY
Other - Last Name:TIBBITS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3831 WELLINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:CAZENOVIA
Mailing Address - State:NY
Mailing Address - Zip Code:13035-9431
Mailing Address - Country:US
Mailing Address - Phone:315-530-3874
Mailing Address - Fax:
Practice Address - Street 1:3831 WELLINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:CAZENOVIA
Practice Address - State:NY
Practice Address - Zip Code:13035
Practice Address - Country:US
Practice Address - Phone:315-530-3874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical