Provider Demographics
NPI:1700952652
Name:DAREFF-WENN, MARCIA JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:JO
Last Name:DAREFF-WENN
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 1:18 COYOTE WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:NY
Mailing Address - Zip Code:12946
Mailing Address - Country:US
Mailing Address - Phone:518-523-7840
Mailing Address - Fax:
Practice Address - Street 1:18 COYOTE WAY
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:NY
Practice Address - Zip Code:12946
Practice Address - Country:US
Practice Address - Phone:512-523-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063661-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical