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Organization
MARY ANDERSON LCSW PC
Active
Organization
MARY ANDERSON LCSW PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARY ANDERSON (OWNER)
(631) 941-9494
Entity
Organization
Contact information
Practice address
9 BAYWOOD LN, BAYPORT, NY 11705-1727
(631) 941-9494
(631) 941-9494
Mailing address
9 BAYWOOD LN, BAYPORT, NY 11705-1727
(631) 941-9494
(631) 941-9494
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
R0505421
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
61020463081
—
NY
Enumeration date
10/12/2006
Last updated
06/08/2022
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