Provider Demographics
NPI:1962558155
Name:MAYRICK, CARA (LCSW)
Entity type:Individual
Prefix:MS
First Name:CARA
Middle Name:
Last Name:MAYRICK
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 1:57 BOWMAN LN
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-2008
Mailing Address - Country:US
Mailing Address - Phone:516-782-2302
Mailing Address - Fax:
Practice Address - Street 1:57 BOWMAN LN
Practice Address - Street 2:
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-2008
Practice Address - Country:US
Practice Address - Phone:516-782-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043756-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical