Provider Demographics
NPI:1053510347
Name:TEICHMAN, MARLENE Z (LCSW, ACSW)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:Z
Last Name:TEICHMAN
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 CENTRAL AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1604
Mailing Address - Country:US
Mailing Address - Phone:516-569-8857
Mailing Address - Fax:
Practice Address - Street 1:360 CENTRAL AVE STE 110
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1604
Practice Address - Country:US
Practice Address - Phone:516-569-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0159891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical