Provider Demographics
NPI:1952470403
Name:PIAZZA, MARJORIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARJORIE
Middle Name:
Last Name:PIAZZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GEDNEY ST.
Mailing Address - Street 2:#3M
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2227
Mailing Address - Country:US
Mailing Address - Phone:845-358-6830
Mailing Address - Fax:
Practice Address - Street 1:103 GEDNEY ST.
Practice Address - Street 2:#3M
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2227
Practice Address - Country:US
Practice Address - Phone:845-358-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018435-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN40822Medicare ID - Type Unspecified
NYN40821Medicare ID - Type Unspecified