Provider Demographics
NPI:1295036135
Name:COX, MARY ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANNE
Middle Name:
Last Name:COX
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:PO BOX 41
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-0041
Mailing Address - Country:US
Mailing Address - Phone:518-643-6894
Mailing Address - Fax:518-643-8709
Practice Address - Street 1:13 ELM ST
Practice Address - Street 2:PERU COMMUNITY CHURCH
Practice Address - City:PERU
Practice Address - State:NY
Practice Address - Zip Code:12972
Practice Address - Country:US
Practice Address - Phone:518-643-6894
Practice Address - Fax:518-643-8709
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073600-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical