Provider Demographics
NPI:1467527812
Name:PAYNE-MARSKY, PATRICIA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARIE
Last Name:PAYNE-MARSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:MARIE
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:630 FT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3900
Mailing Address - Country:US
Mailing Address - Phone:646-387-5436
Mailing Address - Fax:
Practice Address - Street 1:3959 BROADWAY
Practice Address - Street 2:CHONY 6 NORTH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1559
Practice Address - Country:US
Practice Address - Phone:212-305-9923
Practice Address - Fax:212-305-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR035325-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR035325-1OtherSTATE REGISTRATION NUMBER
NYR035325-1OtherSTATE REGISTRATION NUMBER