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General NPI Number Information
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NPI Number | 1043825029
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Entity Type | Organization
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Legal Business Name | MARY LEROUGE LCSW PLLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 720 ROUTE 17M
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City | MIDDLETOWN
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State | NY
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Zip | 10940-4346
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Country | US
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Telephone | 845-391-3812
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Fax |
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Provider Business Mailing Address
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Address Line | 14 SPROAT ST
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City | MIDDLETOWN
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State | NY
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Zip | 10940-3713
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Country | US
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Telephone | 845-551-6534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY LEROUGE
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Credential | LCSW
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Telephone | 845-551-6534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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