Provider Demographics
NPI:1124474481
Name:PEARCE, MARY ELLEN
Entity type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:PEARCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SAINT NICHOLAS TER
Mailing Address - Street 2:APT 24
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-2832
Mailing Address - Country:US
Mailing Address - Phone:704-996-6402
Mailing Address - Fax:
Practice Address - Street 1:1841 PARK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1316
Practice Address - Country:US
Practice Address - Phone:646-459-6142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker