Provider Demographics
NPI:1093861155
Name:WARCHOL, MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:WARCHOL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:17 VAN ALST ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-255-7469
Mailing Address - Fax:
Practice Address - Street 1:276 HUDSON STREET
Practice Address - Street 2:HUDSON CENTER
Practice Address - City:CORNWALL ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12520
Practice Address - Country:US
Practice Address - Phone:845-534-2926
Practice Address - Fax:845-534-3518
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0276901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN9K151Medicare ID - Type Unspecified