Healthcare Provider Details

I. General information

NPI: 1891896403
Provider Name (Legal Business Name): MARY P WEGERSKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 WORTHINGTON TER
WYNANTSKILL NY
12198-2305
US

IV. Provider business mailing address

605 WORTHINGTON TER
WYNANTSKILL NY
12198-2305
US

V. Phone/Fax

Practice location:
  • Phone: 727-667-7281
  • Fax:
Mailing address:
  • Phone: 727-667-7281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2025031886
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number037568
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: