Provider Demographics
NPI:1083816821
Name:METZENDORF, MARGUERITE F (LCSWR)
Entity Type:Individual
Prefix:MRS
First Name:MARGUERITE
Middle Name:F
Last Name:METZENDORF
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:MS
Other - First Name:MARGUERITE
Other - Middle Name:F
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:21 CHARLES ST
Mailing Address - Street 2:21 CHARLES STREET
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-4023
Mailing Address - Country:US
Mailing Address - Phone:631-580-4247
Mailing Address - Fax:631-580-4247
Practice Address - Street 1:21 CHARLES ST
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4023
Practice Address - Country:US
Practice Address - Phone:631-580-4247
Practice Address - Fax:631-580-4247
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0431431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health