Provider Demographics
NPI:1245326685
Name:ORICHOWSKY, MARYELLEN P (MSW/LCSW)
Entity type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:P
Last Name:ORICHOWSKY
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 TATTERSALL DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016
Mailing Address - Country:US
Mailing Address - Phone:609-267-9339
Mailing Address - Fax:609-267-6655
Practice Address - Street 1:25 IKEA DR
Practice Address - Street 2:
Practice Address - City:WESTAMPTON
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-267-9339
Practice Address - Fax:609-267-6655
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC045034001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ904263BSUOtherMEDICARE
904263BSUMedicare ID - Type Unspecified