Provider Demographics
NPI:1548240708
Name:SCOLLAN, MARY ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANNE
Last Name:SCOLLAN
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 1:2290 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2518
Mailing Address - Country:US
Mailing Address - Phone:585-261-6979
Mailing Address - Fax:
Practice Address - Street 1:2290 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-2518
Practice Address - Country:US
Practice Address - Phone:585-261-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0481441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010048144OtherBLUE CHOICE/RIPA
NY110642OtherPREFERRED CARE
P83733Medicare UPIN
NYP010048144OtherBLUE CHOICE/RIPA