Provider Demographics
NPI:1770655318
Name:SHOVER, MARCY E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCY
Middle Name:E
Last Name:SHOVER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:SHOVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:14 STUDIO HILL RD
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1331
Mailing Address - Country:US
Mailing Address - Phone:914-762-4948
Mailing Address - Fax:914-762-3397
Practice Address - Street 1:14 STUDIO HILL RD
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1331
Practice Address - Country:US
Practice Address - Phone:914-762-4948
Practice Address - Fax:914-762-3397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYLCSW R147261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNO3351Medicare ID - Type UnspecifiedLCSW R14726