Provider Demographics
NPI:1508055773
Name:HENNESSY, MARY D (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:D
Last Name:HENNESSY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 TEATOR LN
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-2389
Mailing Address - Country:US
Mailing Address - Phone:845-758-0241
Mailing Address - Fax:
Practice Address - Street 1:30 BENNER RD
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1543
Practice Address - Country:US
Practice Address - Phone:845-758-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025168101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health