Provider Demographics
NPI:1083867576
Name:MARDER, DONNA GERARD (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:GERARD
Last Name:MARDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 QUAKER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CROTON ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10520-3518
Mailing Address - Country:US
Mailing Address - Phone:914-271-4514
Mailing Address - Fax:413-337-4307
Practice Address - Street 1:2224 QUAKER RIDGE RD
Practice Address - Street 2:
Practice Address - City:CROTON ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10520-3518
Practice Address - Country:US
Practice Address - Phone:914-271-4514
Practice Address - Fax:413-337-4307
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSWPR0086331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N0971Medicare PIN