Provider Demographics
NPI:1720561509
Name:MULDOON, MARIANNE (LCSW/R)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:MULDOON
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 1:326 VINCENT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:212-933-0710
Mailing Address - Fax:212-933-0710
Practice Address - Street 1:326 VINCENT AVENUE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563
Practice Address - Country:US
Practice Address - Phone:212-933-0710
Practice Address - Fax:212-933-0710
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047957-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical