Provider Demographics
NPI:1386070621
Name:PLONKA, MARY A (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:PLONKA
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 1:112 SOUTH CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-9634
Mailing Address - Country:US
Mailing Address - Phone:716-373-6735
Mailing Address - Fax:888-622-1235
Practice Address - Street 1:112 SOUTH CLINTON ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-9634
Practice Address - Country:US
Practice Address - Phone:716-373-6735
Practice Address - Fax:888-622-1235
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0848831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical