Mary Agnes Mantilla, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

068980-1 Issued in NY

Practice address

3 Neptune Rd Ste A18F
Poughkeepsie, NY 12601-5500

Phone

(845) 549-8223

NPI assigned

Aug 18, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary A. Tor Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mary Mantilla LCSW, PLLC

  • Community/Behavioral Health Agency
  • Poughkeepsie, NY
  • NPI 1427871664
  NPD Authorized official

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490832000000",
    "number": "1609868439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEPTUNE RD STE A18F",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126015500",
            "telephone_number": "845-549-8223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 NEPTUNE RD STE A18F",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126015500",
            "telephone_number": "845-549-8223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTILLA",
        "first_name": "MARY",
        "middle_name": "AGNES",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2017-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "068980-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMSW LICENSE",
            "identifier": "068980-1",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "TOR",
            "middle_name": "A.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Mano, LMSW
• Neha Manocha
• Gretchen Mansell
• Mohammad Naser Mohammad Mansour, M.D.
• Faisal Mansur
• Sarah A. Marandi-Steeves, LCSW
• Maratelle
• Rachel Lynn Marbach, LMSW
• Jaime Sharna Marcellin, RN
• Michael Joseph Marchan, PHYSICIAN ASSISTANT

• Clinical Social Worker in Poughkeepsie, NY
• Providers in Poughkeepsie, 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 Mar 30, 2017; 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.