Provider Demographics
NPI:1104564749
Name:THELLIYANKAL, MARYKUTTY MATHEW (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARYKUTTY
Middle Name:MATHEW
Last Name:THELLIYANKAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:MARYKUTTY
Other - Middle Name:MATHEW
Other - Last Name:THALACHIRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:10 COUNTY CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1537
Mailing Address - Country:US
Mailing Address - Phone:914-461-2803
Mailing Address - Fax:
Practice Address - Street 1:10 COUNTY CENTER RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1537
Practice Address - Country:US
Practice Address - Phone:914-461-2803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker