Provider Demographics
NPI:1245239961
Name:SUGARMAN, MARJORIE BETH (LCSW-R, BCD, DCSW)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:BETH
Last Name:SUGARMAN
Suffix:
Gender:F
Credentials:LCSW-R, BCD, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 EVERIT PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-1703
Mailing Address - Country:US
Mailing Address - Phone:631-361-7828
Mailing Address - Fax:631-361-9455
Practice Address - Street 1:11 EVERIT PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-1703
Practice Address - Country:US
Practice Address - Phone:631-361-7828
Practice Address - Fax:631-361-9455
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR187111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical