1649282781 NPI number — MRS. MARY ANN CATHERINE MARZEN LCSW

Table of content: MRS. MARY ANN CATHERINE MARZEN LCSW (NPI 1649282781)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649282781 NPI number — MRS. MARY ANN CATHERINE MARZEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARZEN
Provider First Name:
MARY ANN
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649282781
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:
917 CENTER STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JIM THORPE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18229-2209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-325-4414
Provider Business Mailing Address Fax Number:
570-325-8781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 LLANFAIR CIRCLE
Provider Second Line Business Practice Location Address:
SENIOR BEHAVIORAL HEALTHCARE GROUP INC.
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19003-3312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-6769
Provider Business Practice Location Address Fax Number:
610-649-4190
Provider Enumeration Date:
08/13/2006

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:  CW004599L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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