Provider Demographics
NPI:1568533354
Name:MCINERNEY, MARYANN V (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:V
Last Name:MCINERNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NOT APPLICABLE
Other - Middle Name:NOT APPLICABLE
Other - Last Name:NNOT APPLICABLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:15 BELLPORT LN
Mailing Address - Street 2:SUITE 15D
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2751
Mailing Address - Country:US
Mailing Address - Phone:631-286-4779
Mailing Address - Fax:631-286-6323
Practice Address - Street 1:15 BELLPORT LN
Practice Address - Street 2:SUITE 15D
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2751
Practice Address - Country:US
Practice Address - Phone:631-286-4779
Practice Address - Fax:631-286-6323
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO19618-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY078943OtherVALUE OPTIONS
NY081336000OtherMAGELLAN
NYP2635131OtherOXFORD
NY028495OtherMANAGED HEALTH NETWORK
NY16506OtherVYTRA