Provider Demographics
NPI:1720223688
Name:EGAN, MARSHA CHRISTINE (MS/CAS SCHOOL PSYCH)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:CHRISTINE
Last Name:EGAN
Suffix:
Gender:F
Credentials:MS/CAS SCHOOL PSYCH
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:
Other - Last Name:RIESENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:170 INTREPID LANE
Mailing Address - Street 2:HI PEAKS REHAB/DEVELOPMENT
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13205
Mailing Address - Country:US
Mailing Address - Phone:315-492-8319
Mailing Address - Fax:315-492-3758
Practice Address - Street 1:910 2ND STREET
Practice Address - Street 2:LIVERPOOL CENT. SCHOOLS SOUL RD MIDDLE DONLIN DR. ELEME
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-453-0249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYID892602904103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist