Provider Demographics
NPI:1699786285
Name:MCCALLION, MARY S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:S
Last Name:MCCALLION
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:PO BOX 148
Mailing Address - Street 2:162 COUNTRY RD 14
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:13680-0148
Mailing Address - Country:US
Mailing Address - Phone:315-344-7254
Mailing Address - Fax:
Practice Address - Street 1:4 COMMERCE LANE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-386-8191
Practice Address - Fax:315-386-1410
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO38841-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01995615Medicaid
S091878Medicare UPIN
NY01995615Medicaid