Mary-Beth Petersen-Cleary, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00056518 Issued in NY

Practice address

3370 Delaware Ave
Kenmore, NY 14217-1425

Phone

(716) 877-8822

Fax

(716) 874-5245

NPI assigned

May 4, 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

Other identifiers 2

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.

• Catholic Charities of Buffalo

  • Community/Behavioral Health Agency
  • Buffalo, NY
  • NPI 1962596718
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401926400000",
    "number": "1912955865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 DELAWARE AVE",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142092201",
            "telephone_number": "716-218-1400",
            "fax_number": "716-332-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3370 DELAWARE AVE",
            "city": "KENMORE",
            "state": "NY",
            "postal_code": "142171425",
            "telephone_number": "716-877-8822",
            "fax_number": "716-874-5245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN-CLEARY",
        "first_name": "MARY-BETH",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2014-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "00056518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNIVERA",
            "identifier": "000302141501",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUESHIELD",
            "identifier": "000590325001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Nicole Perilli
• Julie A Pernick
• Alyssa Perrine
• Nicole Anne Perrotta, COTA
• Sara Ann Persutti, MS, OTR/L
• Cynthia M Peterson
• Jason Paul Petrie, MS, OTR/L
• Lisa Christine Petty, PT, DPT
• David V. Pew, LMHC
• David F Pfalzer, MD

• Clinical Social Worker in Kenmore, NY
• Providers in Kenmore, 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 5, 2014; 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.