Mary Anderson LCSW PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R0505421 Issued in NY

Legal business name

MARY ANDERSON LCSW PC

Practice address

9 Baywood LN
Bayport, NY 11705-1727

Phone

(631) 941-9494

Fax

(631) 941-9494

NPI assigned

Oct 12, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary AndersonNPI 1245329796

Title

Owner

Phone

(631) 941-9494

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Tax ID family

Mary Anderson LCSW PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mary Anderson LCSW PC

  • Clinical Social Worker
  • Bayport, NY
  • NPI 1508505645
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mary Anderson, LCSWR

  • Clinical Social Worker
  • Bayport, NY
  • NPI 1245329796
  Medicare reassignment Authorized official
• John Michael Donoghue, LCSW

  • Clinical Social Worker
  • South Setauket, NY
  • NPI 1376580555
  NPD (past)
• Caryn J. Gluick, M.A., CCC-SLP

  • Speech-Language Pathologist
  • Port Jefferson, NY
  • NPI 1588899280
  NPD (past)
• Colleen Jean Kalman, LCSW

  • Clinical Social Worker
  • Patchogue, NY
  • NPI 1346324241
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654646400000",
    "number": "1508955022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 BAYWOOD LN",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117051727",
            "telephone_number": "631-941-9494",
            "fax_number": "631-941-9494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 BAYWOOD LN",
            "city": "BAYPORT",
            "state": "NY",
            "postal_code": "117051727",
            "telephone_number": "631-941-9494",
            "fax_number": "631-941-9494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ANDERSON LCSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2022-06-08",
        "certification_date": "2022-06-08",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "631-941-9494",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R0505421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61020463081",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher John Magnifico, MD
• Samantha Makowski
• Jane D Malone, LCSW, PHD
• Edward F Mannine, RN
• Mary Anderson LCSW PC
• Keara McCarthy
• Jennifer L McDonald, LPN
• Angela McIvor
• Denise McNeill
• Korey Mehlrose

• Clinical Social Worker in Bayport, NY
• Providers in Bayport, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.