Provider Demographics
NPI:1164525119
Name:BURY, MARIANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:BURY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 LYNN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5314
Mailing Address - Country:US
Mailing Address - Phone:718-667-1496
Mailing Address - Fax:718-667-1496
Practice Address - Street 1:3915 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-3425
Practice Address - Country:US
Practice Address - Phone:718-948-7800
Practice Address - Fax:718-948-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR014000-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN10261Medicare UPIN