Provider Demographics
NPI:1336296052
Name:MARTON, JEROME S (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:S
Last Name:MARTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CASTLE HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1501
Mailing Address - Country:US
Mailing Address - Phone:845-358-2165
Mailing Address - Fax:845-727-4910
Practice Address - Street 1:4 CASTLE HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1501
Practice Address - Country:US
Practice Address - Phone:845-358-2165
Practice Address - Fax:845-727-4910
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO12140-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N05271Medicare ID - Type Unspecified