Provider Demographics
NPI:1396034385
Name:MEYER, MARY DENYSE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DENYSE
Last Name:MEYER
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 1:116 DUNLOP RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3934
Mailing Address - Country:US
Mailing Address - Phone:630-772-7340
Mailing Address - Fax:
Practice Address - Street 1:140 E MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2844
Practice Address - Country:US
Practice Address - Phone:631-204-8224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081237-1104100000X
NY0949861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker