Provider Demographics
NPI:1912062613
Name:AMSTEL, MARSHA LEA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:LEA
Last Name:AMSTEL
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 1:203 WATERSIDE PROFESSIONAL PARK
Mailing Address - Street 2:PO BOX 112
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3505
Mailing Address - Country:US
Mailing Address - Phone:914-528-8690
Mailing Address - Fax:914-528-2701
Practice Address - Street 1:203 WATERSIDE PROFESSIONAL PARK
Practice Address - Street 2:SUITE 203
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3505
Practice Address - Country:US
Practice Address - Phone:914-528-8690
Practice Address - Fax:914-528-2701
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR013184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health