Provider Demographics
NPI:1174688766
Name:KAYE, MARCIA JOAN (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:JOAN
Last Name:KAYE
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 1:13 RIVER ROAD
Mailing Address - Street 2:APT J
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3425
Mailing Address - Country:US
Mailing Address - Phone:973-235-0570
Mailing Address - Fax:973-235-0570
Practice Address - Street 1:13 RIVER ROAD
Practice Address - Street 2:APT J
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3425
Practice Address - Country:US
Practice Address - Phone:973-235-0570
Practice Address - Fax:973-235-0570
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001454001041C0700X
NYR00668411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
634432Medicare ID - Type Unspecified