Provider Demographics
NPI:1851362743
Name:MARCELLUS, RALPH KIRSCHNER (MSW, LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:KIRSCHNER
Last Name:MARCELLUS
Suffix:
Gender:M
Credentials:MSW, LCSW-R
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Other - First Name:
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Mailing Address - Street 1:24384 NYS RTE 12
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5012
Mailing Address - Country:US
Mailing Address - Phone:315-772-9807
Mailing Address - Fax:315-788-3550
Practice Address - Street 1:BLDG. T-2228, FT DRUM N.Y.
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5004
Practice Address - Country:US
Practice Address - Phone:315-772-8801
Practice Address - Fax:315-772-4097
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYR030329-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical