Healthcare Provider Details

I. General information

NPI: 1952461253
Provider Name (Legal Business Name): MS. MARY PATRICIA GALVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 VETERANS AVE
BATH NY
14810-0810
US

IV. Provider business mailing address

178 SOUTH PL
CORNING NY
14830-2220
US

V. Phone/Fax

Practice location:
  • Phone: 607-664-4000
  • Fax:
Mailing address:
  • Phone: 607-769-2460
  • Fax: 607-936-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number060900-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: