Provider Demographics
NPI:1750399804
Name:MARDER-MIRMAN, EILEEN (MS, NCC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:
Last Name:MARDER-MIRMAN
Suffix:
Gender:F
Credentials:MS, NCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 THE LOCH
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-4522
Mailing Address - Country:US
Mailing Address - Phone:516-763-1841
Mailing Address - Fax:
Practice Address - Street 1:13 THE LOCH
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-4522
Practice Address - Country:US
Practice Address - Phone:516-763-1841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000728101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health