Provider Demographics
NPI:1871983213
Name:MCCARY, LURESA LYNN (CEO)
Entity type:Individual
Prefix:
First Name:LURESA
Middle Name:LYNN
Last Name:MCCARY
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:LURESA
Other - Middle Name:LYNN
Other - Last Name:MCCARY-VAUGHN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CEO
Mailing Address - Street 1:16 ROCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4744
Mailing Address - Country:US
Mailing Address - Phone:516-262-1626
Mailing Address - Fax:
Practice Address - Street 1:16 ROCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4744
Practice Address - Country:US
Practice Address - Phone:516-262-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator