Provider Demographics
NPI:1811379522
Name:KING, MARY KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY KAY
Middle Name:
Last Name:KING
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 1:40 W 72ND ST
Mailing Address - Street 2:APT. 91B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4119
Mailing Address - Country:US
Mailing Address - Phone:917-715-2309
Mailing Address - Fax:
Practice Address - Street 1:40 W 72ND ST
Practice Address - Street 2:APT. 91B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4119
Practice Address - Country:US
Practice Address - Phone:917-715-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080132-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical