| Mary Lorraine Petersen, Csw Pc | |
|
705 Hilltop Ct Coram NY 11727-3640 | |
| (631) 988-9812 | |
| Not Available |
| Full Name | Mary Lorraine Petersen, Csw Pc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 705 Hilltop Ct, Coram, New York |
| Authorized Official Name and Position | Mary Lorraine Petersen (PRESIDENT) |
| Authorized Official Contact | 6319889812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Lorraine Petersen, Csw Pc 705 Hilltop Ct Coram NY 11727-3640 Ph: (631) 988-9812 | Mary Lorraine Petersen, Csw Pc 705 Hilltop Ct Coram NY 11727-3640 Ph: (631) 988-9812 |
| NPI Number | 1568892214 |
|---|---|
| Provider Enumeration Date | 11/16/2013 |
| Last Update Date | 12/06/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568892214 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | R023294 (New York) | Primary |
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