Provider Demographics
NPI:1144348608
Name:EDLOW, MARY FIELDING (MARY)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:FIELDING
Last Name:EDLOW
Suffix:
Gender:F
Credentials:MARY
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:EDLOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:35 EAST 85TH STREET
Mailing Address - Street 2:APT. 5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0966
Mailing Address - Country:US
Mailing Address - Phone:212-861-8682
Mailing Address - Fax:212-535-7177
Practice Address - Street 1:35 E 85TH ST
Practice Address - Street 2:APT 5N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0961
Practice Address - Country:US
Practice Address - Phone:212-861-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0383371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP068457OtherOXFORD
NYP068457OtherOXFORD