Provider Demographics
NPI:1578894226
Name:HENNESSEY, MARY L (LMSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-1228
Mailing Address - Country:US
Mailing Address - Phone:518-483-3261
Mailing Address - Fax:518-483-3383
Practice Address - Street 1:209 PARK ST
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:NY
Practice Address - Zip Code:12953-1228
Practice Address - Country:US
Practice Address - Phone:518-483-3261
Practice Address - Fax:518-483-3383
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073753104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker