Individual
MARY ANNE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-R
Contact information
Practice address
165 MAIN ST., SUITE A, CORTLAND, NY 13045-3049
(607) 753-0234
(607) 753-0286
Mailing address
10 N MAIN ST, CORTLAND, NY 13045-2130
(607) 753-0234
(607) 753-0286
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
R052643
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336163963
—
NY
Enumeration date
06/17/2013
Last updated
03/05/2021
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