Provider Demographics
NPI:1710271093
Name:DEARING, MARY CAROL (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARY CAROL
Middle Name:
Last Name:DEARING
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5428
Mailing Address - Country:US
Mailing Address - Phone:716-998-9263
Mailing Address - Fax:716-633-6902
Practice Address - Street 1:5500 MAIN ST
Practice Address - Street 2:SUITE207
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6755
Practice Address - Country:US
Practice Address - Phone:716-633-6900
Practice Address - Fax:716-633-6902
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-04
Last Update Date:2011-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033004-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical