Provider Demographics
NPI:1437242435
Name:BERTOLINI, MARY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BERTOLINI
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 1:521 BEACH 20 ST
Mailing Address - Street 2:ST JOHN'S EPISCOPAL HOSPITAL CMHC
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2015
Mailing Address - Country:US
Mailing Address - Phone:718-869-8822
Mailing Address - Fax:
Practice Address - Street 1:327 BEACH 19TH STREET
Practice Address - Street 2:ST JOHN'S EPISCOPAL HOSPITAL CMHC
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11691
Practice Address - Country:US
Practice Address - Phone:718-869-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0759151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical