Provider Demographics
NPI:1629398839
Name:PASSMORE, MARIANNE S (LCSW R)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:S
Last Name:PASSMORE
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N MAIN ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2901
Mailing Address - Country:US
Mailing Address - Phone:607-737-4040
Mailing Address - Fax:
Practice Address - Street 1:100 N MAIN ST
Practice Address - Street 2:SUITE 214
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2901
Practice Address - Country:US
Practice Address - Phone:607-737-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO337001103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling