Provider Demographics
NPI:1528209111
Name:SORRENDINO, MARY (LMHC, CASAC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:SORRENDINO
Suffix:
Gender:F
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S WARREN ST
Mailing Address - Street 2:SUITE 508 STATE TOWER BUILDING
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1798
Mailing Address - Country:US
Mailing Address - Phone:315-475-1771
Mailing Address - Fax:315-475-4601
Practice Address - Street 1:109 S WARREN ST
Practice Address - Street 2:SUITE 508 STATE TOWER BUILDING
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1798
Practice Address - Country:US
Practice Address - Phone:315-475-1771
Practice Address - Fax:315-475-4601
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18873101YA0400X
NY003190-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health