Healthcare Provider Details

I. General information

NPI: 1659529220
Provider Name (Legal Business Name): MARY HUTCHENS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 WARREN RD
ITHACA NY
14850-1862
US

IV. Provider business mailing address

3226 WILKINS RD
ITHACA NY
14850-9568
US

V. Phone/Fax

Practice location:
  • Phone: 607-257-1551
  • Fax:
Mailing address:
  • Phone: 607-272-5891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075140-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: