Mary Lorraine Petersen, CSW PC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R023294 Issued in NY

Legal business name

MARY LORRAINE PETERSEN, CSW PC

Practice address

705 Hilltop CT
Coram, NY 11727-3640

Phone

(631) 988-9812

NPI assigned

Nov 16, 2013

Organization subpart

No

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

Authorized official

Name

Ms. Mary Lorraine Petersen, LCSW

Title

President

Phone

(631) 988-9812

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1384560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386288000000",
    "number": "1568892214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 HILLTOP CT",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117273640",
            "telephone_number": "631-988-9812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 HILLTOP CT",
            "city": "CORAM",
            "state": "NY",
            "postal_code": "117273640",
            "telephone_number": "631-988-9812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY LORRAINE PETERSEN, CSW PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-16",
        "last_updated": "2013-12-06",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARY LORRAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-988-9812",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R023294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dorothy Marone
• Christopher Martello, DPT
• Christina Ashley Martino, LMSW
• Helen Martino
• Jenny Martinsen
• Danielle Mascellaro, L.P.N.
• Denise Massaro, R. N
• Jeannine Maytan, LM
• Nina Marie Marie Mazzone
• Helen Theresa McCarthy, RPH

• Clinical Social Worker in Coram, NY
• Providers in Coram, 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 Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.