Mantilla, Mary Agnes
Mantilla, Mary Agnes is an sole proprietor health care provider with primary practice located at 3 Neptune Rd Ste A18F , Poughkeepsie NY 12601-5500. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Mantilla, Mary Agnes can be contacted via phone (845) 549-8223.Contact Information
Primary practice address
3 Neptune Rd Ste A18F
Poughkeepsie NY 12601-5500
Phone: (845) 549-8223
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 068980-1 | New York |
Profile Details
| NPI number | 1609868439 |
|---|---|
| LBN Legal business name | Mantilla, Mary Agnes |
| Credentials | Licensed Clinical Social Worker (LCSW) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 18th, 2005 |
| Last updated | Mar 30th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1609868439 | NPPES |
| New York | Other | 068980-1 | LMSW LICENSE |
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