Healthcare Provider Details

I. General information

NPI: 1174999437
Provider Name (Legal Business Name): MARY T DENNING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BROADHOLLOW RD SUITE 204
FARMINGDALE NY
11735-4820
US

IV. Provider business mailing address

22 PARSONS DR
STONY BROOK NY
11790-2615
US

V. Phone/Fax

Practice location:
  • Phone: 631-741-7719
  • Fax:
Mailing address:
  • Phone: 631-921-9138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number087201
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: