Provider Demographics
NPI:1184868168
Name:MARCIN, THERESA (LCSW)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:MARCIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:ANN
Other - Last Name:COLAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:152 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2847
Mailing Address - Country:US
Mailing Address - Phone:914-479-5411
Mailing Address - Fax:914-479-5411
Practice Address - Street 1:152 BROADWAY
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2847
Practice Address - Country:US
Practice Address - Phone:914-479-5411
Practice Address - Fax:914-479-5411
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056424-11041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical