Provider Demographics
NPI:1760534457
Name:MARCANO, ANGEL LUIS (LMSW)
Entity Type:Individual
Prefix:MR
First Name:ANGEL
Middle Name:LUIS
Last Name:MARCANO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E. 188 ST3, 4TH FLOOR
Mailing Address - Street 2:FORDHAM-TREMONT MHC
Mailing Address - City:BX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-960-0445
Mailing Address - Fax:718-933-8208
Practice Address - Street 1:260 E. 188 ST3, 4TH FLOOR
Practice Address - Street 2:FORDHAM-TREMONT MHC
Practice Address - City:BX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-960-0445
Practice Address - Fax:718-933-8208
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY076683-1101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor