Provider Demographics
NPI:1265405641
Name:MARSHAK, FLO (LCSW)
Entity type:Individual
Prefix:MS
First Name:FLO
Middle Name:
Last Name:MARSHAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:FLORA
Other - Middle Name:
Other - Last Name:MARSHAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 KARL AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-724-5500
Mailing Address - Fax:631-724-5500
Practice Address - Street 1:50 KARL AVE
Practice Address - Street 2:STE 205
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-724-5500
Practice Address - Fax:631-724-5500
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR05206411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01650128Medicaid
NY01650128Medicaid
S23386Medicare UPIN