Provider Demographics
NPI:1427278266
Name:PAQUETTE, MARY PRYAL (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PRYAL
Last Name:PAQUETTE
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 1:18 RALPH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-3412
Mailing Address - Country:US
Mailing Address - Phone:914-948-1903
Mailing Address - Fax:
Practice Address - Street 1:DAVIS AVE AT E POST RD
Practice Address - Street 2:WPHC-MHC (4C)
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4615
Practice Address - Country:US
Practice Address - Phone:914-681-2222
Practice Address - Fax:914-681-2284
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0232761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical