Provider Demographics
NPI:1598943920
Name:MARSON LICENSED CLINICAL SOCIAL WORK AND CONSULTING SERVICES, PLLC
Entity Type:Organization
Organization Name:MARSON LICENSED CLINICAL SOCIAL WORK AND CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:CANDIS
Authorized Official - Last Name:MARSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-650-3977
Mailing Address - Street 1:3 WILCOX LN
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-7512
Mailing Address - Country:US
Mailing Address - Phone:631-650-3977
Mailing Address - Fax:
Practice Address - Street 1:3 WILCOX LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-7512
Practice Address - Country:US
Practice Address - Phone:631-650-3977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0706551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty