Provider Demographics
NPI:1235904392
Name:MCWADE, MARIETTA (LMSW)
Entity Type:Individual
Prefix:
First Name:MARIETTA
Middle Name:
Last Name:MCWADE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MOOG RD
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10524-4220
Mailing Address - Country:US
Mailing Address - Phone:914-557-2900
Mailing Address - Fax:914-557-2900
Practice Address - Street 1:53 MOOG RD
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:NY
Practice Address - Zip Code:10524-4220
Practice Address - Country:US
Practice Address - Phone:914-557-2900
Practice Address - Fax:914-557-2900
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061995-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker