Mary Mai Iwanenko, MS, OTR/L, ATP, SI/C

Primary specialty

SpecialistTaxonomy code 174400000X

License

006633-1 Issued in NY

Practice address

1025 Ridge Rd
Lackawanna, NY 14218-1755

Phone

(716) 822-4781

Fax

(716) 362-8989

NPI assigned

Jan 18, 2008

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)

Not enrolled

Credentials

Master of Science

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.

• Childpro of Western New York

  • Specialist
  • Lackawanna, NY
  • NPI 1598974594
  NPD (past) Authorized official

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

{
    "created_epoch": "1200614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200614400000",
    "number": "1811173990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 S SHORE BLVD",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181753",
            "telephone_number": "716-362-9121",
            "fax_number": "716-362-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 RIDGE RD",
            "city": "LACKAWANNA",
            "state": "NY",
            "postal_code": "142181755",
            "telephone_number": "716-822-4781",
            "fax_number": "716-362-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IWANENKO",
        "first_name": "MARY",
        "middle_name": "MAI",
        "name_prefix": "Mrs.",
        "credential": "MS, OTR/L, ATP, SI/C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-18",
        "last_updated": "2008-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "006633-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Angeline Houck
• Dennisha Huff
• Sheila Rena Hunt
• Paul Nicholas Hurley, LCSW
• Michael J Ilardo, RPH
• Laura Marie Jablinski, IDC
• Carrie Lee Jacobs, LMSW
• Jennifer Jalil-Contreras, LMSW
• Jennifer Joseph, RDH
• Kevin Francis Kania

• Specialist in Lackawanna, NY
• Providers in Lackawanna, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2008; 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.