Provider Demographics
NPI:1346475050
Name:MARKMAN, MARY ELLEN (LCSW, SAS, SDA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:MARKMAN
Suffix:
Gender:F
Credentials:LCSW, SAS, SDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 W 112TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1898
Mailing Address - Country:US
Mailing Address - Phone:212-875-4683
Mailing Address - Fax:212-875-4566
Practice Address - Street 1:610 W 112TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1898
Practice Address - Country:US
Practice Address - Phone:212-875-4683
Practice Address - Fax:212-875-4566
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070850-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070850-1OtherLICENSE NUMBER