Provider Demographics
NPI:1265633838
Name:REILLY MATHEWS, MARY (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:REILLY MATHEWS
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FAIR MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1638
Mailing Address - Country:US
Mailing Address - Phone:315-853-5310
Mailing Address - Fax:
Practice Address - Street 1:20 FAIR MEADOW LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1638
Practice Address - Country:US
Practice Address - Phone:315-853-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO462061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical