Provider Demographics
NPI:1699872747
Name:MERCURIO-DUNN, ANNE BARBARA (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:BARBARA
Last Name:MERCURIO-DUNN
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 1:4277 MIDDLE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-5315
Mailing Address - Country:US
Mailing Address - Phone:315-735-6484
Mailing Address - Fax:315-735-8545
Practice Address - Street 1:4277 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5315
Practice Address - Country:US
Practice Address - Phone:315-735-6484
Practice Address - Fax:315-735-8545
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0110391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11515423OtherCAQH PROVIDER ID
NYCC5053Medicare ID - Type Unspecified