Provider Demographics
NPI:1417179250
Name:COONS, MARY BETH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:COONS
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 1:1066 STATE ROUTE 213
Mailing Address - Street 2:APT 1
Mailing Address - City:HIGH FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12440-5709
Mailing Address - Country:US
Mailing Address - Phone:845-702-4806
Mailing Address - Fax:
Practice Address - Street 1:1066 STATE ROUTE 213
Practice Address - Street 2:APT 1
Practice Address - City:HIGH FALLS
Practice Address - State:NY
Practice Address - Zip Code:12440-5709
Practice Address - Country:US
Practice Address - Phone:845-702-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR055300-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical