Provider Demographics
NPI:1245543305
Name:DOMMEL, MARSHA LYNN (LMHC)
Entity type:Individual
Prefix:MISS
First Name:MARSHA
Middle Name:LYNN
Last Name:DOMMEL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1510 WATERS PL
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2700
Mailing Address - Country:US
Mailing Address - Phone:718-597-3888
Mailing Address - Fax:718-597-0989
Practice Address - Street 1:1510 WATERS PL
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2700
Practice Address - Country:US
Practice Address - Phone:718-597-3888
Practice Address - Fax:718-597-0989
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)