Provider Demographics
NPI:1508330556
Name:SZURKO, MARISA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:SZURKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 BROOKHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1648
Mailing Address - Country:US
Mailing Address - Phone:862-823-2664
Mailing Address - Fax:
Practice Address - Street 1:301 SICOMAC AVE BLDG 2
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2194
Practice Address - Country:US
Practice Address - Phone:201-848-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-13
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053885001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical