Provider Demographics
NPI:1780738260
Name:FLEISCHMAN, MARYANN (LCSWR)
Entity type:Individual
Prefix:MS
First Name:MARYANN
Middle Name:
Last Name:FLEISCHMAN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CUTCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11935
Mailing Address - Country:US
Mailing Address - Phone:631-734-2443
Mailing Address - Fax:631-734-7430
Practice Address - Street 1:560 HOLDEN AVE
Practice Address - Street 2:
Practice Address - City:CUTCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11935
Practice Address - Country:US
Practice Address - Phone:631-734-2443
Practice Address - Fax:631-734-7430
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0384411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01539179Medicaid
NYN6M991Medicare ID - Type Unspecified