Provider Demographics
NPI:1538490180
Name:MCINERNEY, JOHN T (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:MCINERNEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 N VERNON ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:NY
Mailing Address - Zip Code:12015-1020
Mailing Address - Country:US
Mailing Address - Phone:212-645-8059
Mailing Address - Fax:
Practice Address - Street 1:24 E 12TH ST
Practice Address - Street 2:SUITE 503
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4513
Practice Address - Country:US
Practice Address - Phone:212-645-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 041046-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical