Provider Demographics
NPI:1043662265
Name:KHAREM, MARION BUNCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARION
Middle Name:BUNCE
Last Name:KHAREM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARION
Other - Middle Name:MERCEDES
Other - Last Name:BUNCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:300 S BROADWAY
Mailing Address - Street 2:APT 6A
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5317
Mailing Address - Country:US
Mailing Address - Phone:914-843-2706
Mailing Address - Fax:
Practice Address - Street 1:83 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10901-6408
Practice Address - Country:US
Practice Address - Phone:914-843-2706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR033335-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical