Provider Demographics
NPI:1538286257
Name:MARQUARD, LEE ANN (MSW)
Entity Type:Individual
Prefix:
First Name:LEE ANN
Middle Name:
Last Name:MARQUARD
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 UPPER BLVD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1508
Mailing Address - Country:US
Mailing Address - Phone:201-670-4825
Mailing Address - Fax:
Practice Address - Street 1:1022 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3209
Practice Address - Country:US
Practice Address - Phone:973-694-1234
Practice Address - Fax:973-633-0992
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05224500101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health