Healthcare Provider Details

I. General information

NPI: 1427591890
Provider Name (Legal Business Name): MARY DAE CONCEPCION LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2016
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 N MAIN ST
SPRING VALLEY NY
10977-1902
US

IV. Provider business mailing address

49 5TH AVE # 1
HAWTHORNE NJ
07506-2161
US

V. Phone/Fax

Practice location:
  • Phone: 845-708-2000
  • Fax: 845-708-7040
Mailing address:
  • Phone: 201-753-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number088884
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC06240100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: