Provider Demographics
NPI:1245918275
Name:MATHER, DESIREE ANN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:ANN
Last Name:MATHER
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 1:2100 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12304-4784
Mailing Address - Country:US
Mailing Address - Phone:518-859-4154
Mailing Address - Fax:
Practice Address - Street 1:2100 TOWER AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-4784
Practice Address - Country:US
Practice Address - Phone:518-859-4154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088936-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical