Provider Demographics
NPI:1508505645
Name:MARY ANDERSON LCSW PC
Entity Type:Organization
Organization Name:MARY ANDERSON LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-941-9494
Mailing Address - Street 1:9 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-1727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:631-730-7796
Practice Address - Street 1:9 BAYWOOD LN
Practice Address - Street 2:
Practice Address - City:BAYPORT
Practice Address - State:NY
Practice Address - Zip Code:11705-1727
Practice Address - Country:US
Practice Address - Phone:631-941-9494
Practice Address - Fax:631-730-7796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty