Provider Demographics
NPI:1003867235
Name:LINCOLN, MARY ANNA (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNA
Last Name:LINCOLN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1156 N BROADWAY
Mailing Address - Street 2:ANDRUS CHILDREN'S CENTER
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1108
Mailing Address - Country:US
Mailing Address - Phone:914-965-3700
Mailing Address - Fax:914-965-3883
Practice Address - Street 1:35 DOCK ST
Practice Address - Street 2:ANDRUS CHILDREN'S CENTER MENTAL HEALTH DIVISION
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-2733
Practice Address - Country:US
Practice Address - Phone:914-966-1109
Practice Address - Fax:914-965-9705
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1539582084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940Medicaid
NY153958OtherNY MD LICENSE #
NY1285628552OtherJDAM NPI
NYWVE061Medicare ID - Type UnspecifiedJDAM MEDICARE PROVIDER #