MARY BRONDOU DOUSHARM LCSW
NPI 1356643514
Social Worker - Clinical in Gouverneur, NY

Q: What is Mary Dousharm's NPI number?

The NPI number for Mary Dousharm is 1356643514. It was assigned to this individual provider in the NPPES registry on November 22, 2010.

Q: What is Mary Dousharm's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Q: When was this NPI record last updated?

The NPPES record for Mary Dousharm was last updated on November 22, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since November 22, 2010PECOS EnrolledAccepts Medicare Assignment

28 WILLIAM ST, GOUVERNEUR, NY 13642(315) 287-2811(315) 394-0097 Get Directions Write a Review

NPPES record last updated: November 22, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Mary Brondou Dousharm Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY BRONDOU DOUSHARM LCSW (NPI 1356643514) is an individual clinical provider in Gouverneur, New York, licensed in New York (082898) and active in the NPI registry since November 2010. She is enrolled in Medicare PECOS, is affiliated with Gouverneur Hospital, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1356643514

Entity TypeIndividualFemale

Primary Taxonomy1041C0700X

Provider Legal NameMARY BRONDOU DOUSHARMCredential: LCSW

Location Address28 WILLIAM STGouverneur, NY 13642-1405

Mailing Address50 Leroy StPotsdam, NY 13676-1786 · (315) 265-3300 · Fax (315) 261-6025

Phone(315) 287-2811

Fax(315) 394-0097

Sole ProprietorYes

Medical School CMSOtherGraduated 2010

Enumeration DateNovember 22, 2010

Last NPPES UpdateNovember 22, 2019

✔ NPI 1356643514 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code1041C0700X

License✔ Licensed in NY · 082898

Definition

A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

28 WILLIAM ST, Gouverneur, NY 13642

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary Brondou Dousharm Lcsw is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID345500633

PECOS Enrollment IDI20191219000389

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Gouverneur Hospital

Critical Access Hospitals · Gouverneur, NY

OwnershipVoluntary non-profit - Private

CMS Certification Number331315

Location77 West Barney StreetGouverneur, NY 13642 · St. Lawrence County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 13642 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$0.00 typical visit price

range $54.87 – $166.88

Typical copayment $0.00 (range $13.71 – $41.72)

Most-billed visit code NA

Established Patient

$68.57 typical visit price

range $17.54 – $136.14

Typical copayment $17.14 (range $4.38 – $34.03)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. AMY JO THORBAHN RN,BSN

Registered Nurse (Community Health)