Provider Demographics
NPI:1285945808
Name:PROIETTA-HALPERN, MARY JO (LCSW-R)
Entity type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:PROIETTA-HALPERN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5088 RENE PL
Mailing Address - Street 2:
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-1013
Mailing Address - Country:US
Mailing Address - Phone:131-543-9805
Mailing Address - Fax:315-343-3281
Practice Address - Street 1:5088 RENE PL
Practice Address - Street 2:
Practice Address - City:NORTH SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-1013
Practice Address - Country:US
Practice Address - Phone:315-439-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0758991041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)