Provider Demographics
NPI:1003904764
Name:DAVIDSON-AMODEO, MARIAN RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:RUTH
Last Name:DAVIDSON-AMODEO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:155 W 68TH ST
Mailing Address - Street 2:APT. 1915
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5808
Mailing Address - Country:US
Mailing Address - Phone:212-724-5769
Mailing Address - Fax:212-501-7377
Practice Address - Street 1:120 W 57TH ST
Practice Address - Street 2:ROOM 1115
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3320
Practice Address - Country:US
Practice Address - Phone:212-632-4739
Practice Address - Fax:212-632-4534
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072160-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical