1053470443 NPI number — MRS. MARIANNA ERISMAN MARTIN LCSWR

Table of content: MRS. MARIANNA ERISMAN MARTIN LCSWR (NPI 1053470443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053470443 NPI number — MRS. MARIANNA ERISMAN MARTIN LCSWR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
MARIANNA
Provider Middle Name:
ERISMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSWR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ERISMAN
Provider Other First Name:
MARIANNA
Provider Other Middle Name:
MOON
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053470443
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 TIMBERLINE DR
Provider Second Line Business Mailing Address:
MARIANNA E MARTIN
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-5546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-462-6015
Provider Business Mailing Address Fax Number:
845-462-1483

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1076 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 204 MARIANNA E MARTIN LCSWR
Provider Business Practice Location Address City Name:
FISHKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12524-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-838-7853
Provider Business Practice Location Address Fax Number:
845-462-1483
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R040748 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com