Provider Demographics
NPI:1669600847
Name:WAXMAN, MARNIE S (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARNIE
Middle Name:S
Last Name:WAXMAN
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 1:215 N CAYUGA ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4329
Mailing Address - Country:US
Mailing Address - Phone:607-319-4931
Mailing Address - Fax:
Practice Address - Street 1:120 E BUFFALO ST
Practice Address - Street 2:SUITE 8
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4266
Practice Address - Country:US
Practice Address - Phone:607-319-4931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-26
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0727121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical