Provider Demographics
NPI:1124073234
Name:SCHLECHT, MARY JO (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:SCHLECHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 S UNION ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-1255
Mailing Address - Country:US
Mailing Address - Phone:585-349-4088
Mailing Address - Fax:
Practice Address - Street 1:85 S UNION ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-1255
Practice Address - Country:US
Practice Address - Phone:585-349-4088
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037768-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR037768-1OtherCLINICAL SOCIAL WORKER
NY100409Medicare UPIN