Provider Demographics
NPI:1336335579
Name:MARY OZEGOVICH LCSW PC
Entity type:Organization
Organization Name:MARY OZEGOVICH LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:OZEGOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-650-5580
Mailing Address - Street 1:6 SUFFOLK LN
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2210
Mailing Address - Country:US
Mailing Address - Phone:631-650-5580
Mailing Address - Fax:631-277-2787
Practice Address - Street 1:6 SUFFOLK LN
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2210
Practice Address - Country:US
Practice Address - Phone:631-650-5580
Practice Address - Fax:631-277-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04530611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP575344OtherOXFORD HEALTH PLANS
NY7483559OtherGHI NY
NY082497OtherVALUE OPTIONS
NY045306OtherHIP GREATER NY