Provider Demographics
NPI:1043286248
Name:CLARE, MARY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:CLARE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:277 ALEXANDER ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1920
Mailing Address - Country:US
Mailing Address - Phone:585-262-2820
Mailing Address - Fax:585-271-2198
Practice Address - Street 1:277 ALEXANDER ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1920
Practice Address - Country:US
Practice Address - Phone:585-262-2820
Practice Address - Fax:585-271-2198
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR045025-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
270175OtherVALUE OPTIONS PIN
553863000OtherMAGELLAN
P010045025OtherEXCELLUS PIN
322592OtherMHN PIN
7272513OtherAETNA PIN
201838OtherCOMPSYCH PIN
MDH 240OtherPREFERRED CARE PIN