Provider Demographics
NPI:1013217223
Name:ELBERTH, MARYANN (DSW)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:
Last Name:ELBERTH
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MARYANN LANE
Mailing Address - Street 2:
Mailing Address - City:OTISVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10963
Mailing Address - Country:US
Mailing Address - Phone:845-386-4669
Mailing Address - Fax:
Practice Address - Street 1:2094 ALBANY POST ROAD
Practice Address - Street 2:B13, RM 131
Practice Address - City:MONTROSE
Practice Address - State:NY
Practice Address - Zip Code:10548
Practice Address - Country:US
Practice Address - Phone:914-737-4400
Practice Address - Fax:914-788-4293
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0164491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical