Provider Demographics
NPI:1447510292
Name:DUFORT, MARY (LCSWR)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DUFORT
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 NEW KARNER RD STE 17
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-5841
Mailing Address - Country:US
Mailing Address - Phone:518-456-2060
Mailing Address - Fax:
Practice Address - Street 1:435 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3867
Practice Address - Country:US
Practice Address - Phone:518-456-2060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-25
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083989104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker