Individual
MRS. MARY ANN LAVERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNMSN
Contact information
Practice address
1724 5TH AVE, TROY, NY 12180-3320
(518) 272-3918
(518) 272-6391
Mailing address
1724 5TH AVE, TROY, NY 12180-3320
(518) 272-3918
(518) 272-6391
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
656937-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851452767
—
NY
Enumeration date
06/07/2012
Last updated
06/08/2012
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