Provider Demographics
NPI:1619755071
Name:NIEFER, MARY ELLEN T (MHC-LP)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:T
Last Name:NIEFER
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COUNTY OFFICE BUILDING
Mailing Address - Street 2:5 COURT STREET, SUITE 42
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:CHENANGO COUNTY BEHAVIORAL HEALTH SERVICES
Practice Address - Street 2:COUNTY OFFICE BUILDING, 5 COURT STREET, SUITE 42
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP114256101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health