| Doctor Name: | MRS. MARY KOLESAR |
| NPI Number: | 1578872271 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCSW |
| License Number: | 73074760 |
| Business Practice Address: | 240 Mastic Beach Rd Mastic Beach, NY - 119511028 |
| Business Phone Number: | 6318741103 |
| Business Fax Number: | |
| Mailing Address: | 240 Mastic Beach Rd, MASTIC BEACH |
| State: | NY |
| Postal Code: | 119511028 |
| Phone Number: | 6318741103 |
| Fax Number: | |
| NPI Enumeration Date: | 09/28/2010 |
| NPI Last Update Date: | 09/28/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041S0200X |
| License Number: | 73074760 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |