Provider Demographics
NPI:1396284261
Name:MERCHANT, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1319
Mailing Address - Country:US
Mailing Address - Phone:845-794-8080
Mailing Address - Fax:845-796-3799
Practice Address - Street 1:17 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1319
Practice Address - Country:US
Practice Address - Phone:845-794-8080
Practice Address - Fax:845-796-3799
Is Sole Proprietor?:No
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)