Provider Demographics
NPI:1639284227
Name:MCNAIR, MARYSUE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARYSUE
Middle Name:
Last Name:MCNAIR
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 1:11 NIMITZ PL
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2329
Mailing Address - Country:US
Mailing Address - Phone:732-636-5414
Mailing Address - Fax:732-636-5414
Practice Address - Street 1:11 NIMITZ PL
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2329
Practice Address - Country:US
Practice Address - Phone:732-636-5414
Practice Address - Fax:732-636-5414
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC0018620001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical