Provider Demographics
NPI:1225050099
Name:SUTHERLAND, MARY HENNESSEY (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:HENNESSEY
Last Name:SUTHERLAND
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 1:800 WOODHILLS DR APT 805
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1463
Mailing Address - Country:US
Mailing Address - Phone:845-360-5711
Mailing Address - Fax:
Practice Address - Street 1:367 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-3422
Practice Address - Country:US
Practice Address - Phone:845-703-0384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03948811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical