Provider Demographics
NPI:1639210446
Name:WARRACK, MARIA P (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:P
Last Name:WARRACK
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 1:29 SHELTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4813
Mailing Address - Country:US
Mailing Address - Phone:516-433-4308
Mailing Address - Fax:
Practice Address - Street 1:29 SHELTER HILL RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4813
Practice Address - Country:US
Practice Address - Phone:516-433-4308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0018311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO2451Medicare ID - Type Unspecified