Provider Demographics
NPI:1891226676
Name:KORTES, MARY LEE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEE
Last Name:KORTES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CLIFTON PL
Mailing Address - Street 2:1G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1372
Mailing Address - Country:US
Mailing Address - Phone:646-279-5979
Mailing Address - Fax:
Practice Address - Street 1:110 CLIFTON PL
Practice Address - Street 2:1G
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-1372
Practice Address - Country:US
Practice Address - Phone:646-279-5979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097431-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker