Provider Demographics
NPI:1477542900
Name:MCGRATH, MARY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:MCGRATH
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 1:187 EAST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1609
Mailing Address - Country:US
Mailing Address - Phone:516-735-6700
Mailing Address - Fax:855-262-1981
Practice Address - Street 1:187 EAST DR
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1609
Practice Address - Country:US
Practice Address - Phone:516-735-6700
Practice Address - Fax:855-262-1981
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0416871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9A543Medicare PIN