Provider Demographics
NPI:1023214681
Name:MARSON, BERNADETTE CANDIS (LCSW)
Entity Type:Individual
Prefix:PROF
First Name:BERNADETTE
Middle Name:CANDIS
Last Name:MARSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WILCOX LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7512
Mailing Address - Country:US
Mailing Address - Phone:631-335-7278
Mailing Address - Fax:
Practice Address - Street 1:3 WILCOX LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7512
Practice Address - Country:US
Practice Address - Phone:631-335-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070655-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical