Provider Demographics
NPI:1053814855
Name:ERTOLA, MARCIA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:
Last Name:ERTOLA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BRUCE LATOURRETTE RD
Mailing Address - Street 2:
Mailing Address - City:WALTON
Mailing Address - State:NY
Mailing Address - Zip Code:13856-3334
Mailing Address - Country:US
Mailing Address - Phone:607-865-8036
Mailing Address - Fax:
Practice Address - Street 1:19 BRUCE LATOURRETTE RD
Practice Address - Street 2:
Practice Address - City:WALTON
Practice Address - State:NY
Practice Address - Zip Code:13856-3334
Practice Address - Country:US
Practice Address - Phone:607-865-8036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-18
Last Update Date:2018-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005256-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health