Mary Lorraine Petersen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R023294 Issued in NY

Practice address

705 Hilltop CT
Coram, NY 11727

Phone

(631) 696-4355

NPI assigned

Sep 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710083084",
    "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": "11727",
            "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": "11727",
            "telephone_number": "631-696-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MARY",
        "middle_name": "LORRAINE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R023294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Catherine J Penaloza
• Photina Faye Penn, PHYSICAL THERAPIST
• Jillian Alexa Rae Peralta, LPN
• Eloise Verona Perkins, R.N.
• Paula A Pesce, MASSAGE THERAPIST
• Nicole Ashley Petillo, BCBA, LBA
• James Cutreal Phillips, DPT
• Physical Therapy Rehab Plus, P.C.
• Lee Ann Piccola-Voight, LCSWR
• Michele Piediscalzo

• 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 Jul 8, 2007; 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.