1043286248 NPI number — MS. MARY CLARE LCSW

Table of content: MS. MARY CLARE LCSW (NPI 1043286248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043286248 NPI number — MS. MARY CLARE LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARE
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043286248
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
277 ALEXANDER ST
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14607-1920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-262-2820
Provider Business Mailing Address Fax Number:
585-271-2198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 ALEXANDER ST
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14607-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-262-2820
Provider Business Practice Location Address Fax Number:
585-271-2198
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R045025-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 270175 . This is a "VALUE OPTIONS PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 553863000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P010045025 . This is a "EXCELLUS PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 322592 . This is a "MHN PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7272513 . This is a "AETNA PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201838 . This is a "COMPSYCH PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: MDH 240 . This is a "PREFERRED CARE PIN" identifier . This identifiers is of the category "OTHER".




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