Provider Demographics
NPI:1043290216
Name:MCCLAIN-MARVIN, KAREN (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:MCCLAIN-MARVIN
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:280 MADISON AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0801
Mailing Address - Country:US
Mailing Address - Phone:646-784-7195
Mailing Address - Fax:718-857-6462
Practice Address - Street 1:280 MADISON AVE
Practice Address - Street 2:608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0801
Practice Address - Country:US
Practice Address - Phone:646-784-7195
Practice Address - Fax:718-857-6462
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0399111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005185503Medicare UPIN
NYN1H241Medicare ID - Type Unspecified
NY6237245Medicare UPIN
NY740864Medicare UPIN
NY458635Medicare UPIN
NYN1H24Medicare UPIN