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General NPI Number Information
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NPI Number | 1710271093
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Entity Type | Individual
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Provider Name | MARY CAROL DEARING LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 06/04/2011
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Last Update Date | 06/04/2011
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Provider Practice Location Address
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Address Line | 5500 MAIN ST SUITE207
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6755
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Country | US
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Telephone | 716-633-6900
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Fax | 716-633-6902
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Provider Business Mailing Address
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Address Line | 48 HOWARD AVE
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5428
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Country | US
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Telephone | 716-998-9263
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Fax | 716-633-6902
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R033004-1
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License Number State | NY
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