Provider Demographics
NPI:1619044369
Name:KEY, MARY ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:KEY
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 1:1007 N MAIN ST
Mailing Address - Street 2:PO BOX 839
Mailing Address - City:DAYVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06241-2170
Mailing Address - Country:US
Mailing Address - Phone:860-774-2020
Mailing Address - Fax:860-774-0826
Practice Address - Street 1:233 ROUTE 6
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CT
Practice Address - Zip Code:06237-1125
Practice Address - Country:US
Practice Address - Phone:860-228-4480
Practice Address - Fax:860-228-6921
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW79561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW7956OtherSTATE LICENSE NUMBER