Physician Compare National (NPI:1457463598)

HEALTHCARE PROVIDER: MARY LEE HASBROUCK LCSW

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1457463598
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	6709918881
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100726000469
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	HASBROUCK
	Individual professional last name
Provider First Name	MARY LEE
	Individual professional first name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1978
	Individual professional's medical school graduation year
Primary Specialty	CLINICAL SOCIAL WORKER
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	302 PECONIC AVE
	Group Practice or individual's line 1 address
City	MEDFORD
	Group Practice or individual's city
State	NY
	Group Practice or individual's state
Zip Code	117633549
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6313349229
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y