Basic Information
| Provider Information | |||||||||
| NPI: | 1922777952 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEMENNA | ||||||||
| FirstName: | MARYCLARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 474 8TH ST APT 1L | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112153641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7813674794 | ||||||||
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| Practice Location | |||||||||
| Address1: | 921 E NEW YORK AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112031393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187780485 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2021 | ||||||||
| LastUpdateDate: | 09/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 116915 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.