Provider Demographics
NPI:1770945297
Name:DEBRUHL, MARSHALL WILLIAM ARCHER (LMSW)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:WILLIAM ARCHER
Last Name:DEBRUHL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 LITTLE YORK RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-2231
Mailing Address - Country:US
Mailing Address - Phone:845-545-4618
Mailing Address - Fax:
Practice Address - Street 1:56 LITTLE YORK RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-2231
Practice Address - Country:US
Practice Address - Phone:845-545-4618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 092869104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker