Provider Demographics
NPI:1053470443
Name:MARTIN, MARIANNA ERISMAN (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:MARIANNA
Middle Name:ERISMAN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:MISS
Other - First Name:MARIANNA
Other - Middle Name:MOON
Other - Last Name:ERISMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:44 TIMBERLINE DR
Mailing Address - Street 2:MARIANNA E MARTIN
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-5546
Mailing Address - Country:US
Mailing Address - Phone:845-462-6015
Mailing Address - Fax:845-462-1483
Practice Address - Street 1:1076 MAIN ST
Practice Address - Street 2:SUITE 204 MARIANNA E MARTIN LCSWR
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3606
Practice Address - Country:US
Practice Address - Phone:845-838-7853
Practice Address - Fax:845-462-1483
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0407481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical