| Mary Anderson Lcsw Pc | |
|
9 Baywood Ln Bayport NY 11705-1727 | |
| (631) 941-9494 | |
| (631) 941-9494 |
| Full Name | Mary Anderson Lcsw Pc |
|---|---|
| Speciality | Social Worker |
| Location | 9 Baywood Ln, Bayport, New York |
| Authorized Official Name and Position | Mary Anderson (OWNER) |
| Authorized Official Contact | 6319419494 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Anderson Lcsw Pc 9 Baywood Ln Bayport NY 11705-1727 Ph: (631) 941-9494 | Mary Anderson Lcsw Pc 9 Baywood Ln Bayport NY 11705-1727 Ph: (631) 941-9494 |
| NPI Number | 1508955022 |
|---|---|
| Provider Enumeration Date | 10/12/2006 |
| Last Update Date | 06/08/2022 |
| Certification Date | 06/08/2022 |
| Medicare PECOS PAC ID | 0941190276 |
|---|---|
| Medicare Enrollment ID | O20100209000240 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508955022 | NPI | - | NPPES |
| 61020463081 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R0505421 (New York) | Primary |
| Provider Name | Mary Anderson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245329796 PECOS PAC ID: 4587707849 Enrollment ID: I20100209000210 |
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