Provider Demographics
NPI:1902932049
Name:MAHER, MARIE JULIA (LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:JULIA
Last Name:MAHER
Suffix:
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2319
Mailing Address - Country:US
Mailing Address - Phone:315-685-2280
Mailing Address - Fax:
Practice Address - Street 1:421 MONTGOMERY ST
Practice Address - Street 2:CIVIC CENTER 10TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2923
Practice Address - Country:US
Practice Address - Phone:315-435-3355
Practice Address - Fax:315-435-7710
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12712101YA0400X
NY0778841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00565031Medicaid