Healthcare Provider Details

I. General information

NPI: 1699786285
Provider Name (Legal Business Name): MARY S MCCALLION LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 COMMERCE LANE
CANTON NY
13617
US

IV. Provider business mailing address

PO BOX 148 162 COUNTRY RD 14
RENSSELAER NY
13680-0148
US

V. Phone/Fax

Practice location:
  • Phone: 315-386-8191
  • Fax: 315-386-1410
Mailing address:
  • Phone: 315-344-7254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberRO38841-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: