| Mary Lerouge Lcsw Pllc | |
|
720 Route 17m Middletown NY 10940-4346 | |
| (845) 391-3812 | |
| Not Available |
| Full Name | Mary Lerouge Lcsw Pllc |
|---|---|
| Speciality | Counselor |
| Location | 720 Route 17m, Middletown, New York |
| Authorized Official Name and Position | Mary Lerouge (OWNER) |
| Authorized Official Contact | 8455516534 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lerouge Lcsw Pllc 14 Sproat St Middletown NY 10940-3713 Ph: (845) 551-6534 | Mary Lerouge Lcsw Pllc 720 Route 17m Middletown NY 10940-4346 Ph: (845) 391-3812 |
| NPI Number | 1043825029 |
|---|---|
| Provider Enumeration Date | 09/15/2020 |
| Last Update Date | 03/08/2023 |
| Certification Date | 03/08/2023 |
| Medicare PECOS PAC ID | 3870986060 |
|---|---|
| Medicare Enrollment ID | O20220211000188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043825029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Mary E Lerouge |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700254349 PECOS PAC ID: 6507259793 Enrollment ID: I20220211000348 |
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