Provider Demographics
NPI:1073848156
Name:METZ-MARCUS, LORI A (LCSW)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:METZ-MARCUS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:METZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:240 CENTRAL PARK S APT 7I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1452
Mailing Address - Country:US
Mailing Address - Phone:917-655-9776
Mailing Address - Fax:
Practice Address - Street 1:119 W 57TH ST STE 1100
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2401
Practice Address - Country:US
Practice Address - Phone:917-655-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR032092-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300019619OtherMEDICARE PTAN