Provider Demographics
NPI:1164673679
Name:MARASCO, MARY LOU (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LOU
Last Name:MARASCO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 FT. HILL AVENUE
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-0144
Mailing Address - Country:US
Mailing Address - Phone:585-393-7508
Mailing Address - Fax:585-393-7429
Practice Address - Street 1:400 FORT HILL AVE
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1159
Practice Address - Country:US
Practice Address - Phone:585-393-7508
Practice Address - Fax:585-393-7429
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72077613104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker