Provider Demographics
NPI:1730701038
Name:HOSEY-PARDI, MARY A
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:HOSEY-PARDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1340
Mailing Address - Country:US
Mailing Address - Phone:315-557-2212
Mailing Address - Fax:315-557-2216
Practice Address - Street 1:75 CHENANGO AVE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1340
Practice Address - Country:US
Practice Address - Phone:315-557-2212
Practice Address - Fax:315-557-2216
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW131151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3115OtherSOCIAL WORK
FL3115Medicaid
NY062097OtherLMSW