Provider Demographics
NPI:1831229665
Name:MEYER, MARY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:MEYER
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 1:12280 GENESEE RD
Mailing Address - Street 2:
Mailing Address - City:EAST CONCORD
Mailing Address - State:NY
Mailing Address - Zip Code:14055-9727
Mailing Address - Country:US
Mailing Address - Phone:716-523-0268
Mailing Address - Fax:
Practice Address - Street 1:1200 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:716-517-2226
Practice Address - Fax:716-517-3738
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03349311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical