Provider Demographics
NPI:1336285014
Name:WASHBURN, MARY ELLEN (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MS
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:WASHBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:740 HEWITT LN
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-5462
Mailing Address - Country:US
Mailing Address - Phone:845-565-4393
Mailing Address - Fax:
Practice Address - Street 1:740 HEWITT LN
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-5462
Practice Address - Country:US
Practice Address - Phone:845-565-4393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR01877211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N16111Medicare ID - Type Unspecified