Provider Demographics
NPI:1578872271
Name:KOLESAR, MARY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:KOLESAR
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 1:240 MASTIC BEACH RD
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-1028
Mailing Address - Country:US
Mailing Address - Phone:631-874-1103
Mailing Address - Fax:
Practice Address - Street 1:240 MASTIC BEACH RD
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1028
Practice Address - Country:US
Practice Address - Phone:631-874-1103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730747601041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool