Provider Demographics
NPI:1689964389
Name:MCLARY, DEIRDRE (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:DEIRDRE
Middle Name:
Last Name:MCLARY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 LOCUST DR
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1010
Mailing Address - Country:US
Mailing Address - Phone:845-323-8977
Mailing Address - Fax:
Practice Address - Street 1:122 LOCUST DR
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1010
Practice Address - Country:US
Practice Address - Phone:845-323-8977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11091916174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11091916OtherLACTATION CO