Provider Demographics
NPI:1629190848
Name:MARSH, DEMETRIC (MSW LSW PA LCSW NY)
Entity Type:Individual
Prefix:MS
First Name:DEMETRIC
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:MSW LSW PA LCSW NY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 LESSING PLACE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520
Mailing Address - Country:US
Mailing Address - Phone:516-509-5851
Mailing Address - Fax:
Practice Address - Street 1:60 CHARLES LINDBERGH BLVD
Practice Address - Street 2:SUITE 160 UNIT 4 214
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3686
Practice Address - Country:US
Practice Address - Phone:516-227-8284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW013615104100000X
NY0445901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical