Basic Information
| Provider Information | |||||||||
| NPI: | 1801114210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSEILLE | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18 CHURCH STREET | ||||||||
| Address2: | NYACK CONSULTATION CENTER | ||||||||
| City: | NYACK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109603108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453581677 | ||||||||
| FaxNumber: | 8453583640 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 OLD ORANGEBURG ROAD | ||||||||
| Address2: | ROCKLAND PSYCHIATRIC CENTER | ||||||||
| City: | ORANGEBURG | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453591000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2010 | ||||||||
| LastUpdateDate: | 05/10/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 064880 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.