1740343144 NPI number — MARCELLA ST CLAIR LCSW

Table of content: MARCELLA ST CLAIR LCSW (NPI 1740343144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740343144 NPI number — MARCELLA ST CLAIR LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST CLAIR
Provider First Name:
MARCELLA
Provider Middle Name:
Provider Name Prefix Text:
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:
1740343144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE BROOKDALE PLAZA , CHILD OUTPATIENT PSYC ,12TH FLOOR
Provider Second Line Business Mailing Address:
BROOKDALE HOSPITAL MEDICAL CENTER
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11212-3198
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-240-5479
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
887 E NEW YORK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-467-6441
Provider Business Practice Location Address Fax Number:
718-498-6868
Provider Enumeration Date:
12/18/2006

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: 104100000X , with the licence number:  R042593-1 , 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)

  • Identifier: 0024931 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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