1851362743 NPI number — MR. RALPH KIRSCHNER MARCELLUS MSW, LCSW-R

Table of content: MR. RALPH KIRSCHNER MARCELLUS MSW, LCSW-R (NPI 1851362743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851362743 NPI number — MR. RALPH KIRSCHNER MARCELLUS MSW, LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARCELLUS
Provider First Name:
RALPH
Provider Middle Name:
KIRSCHNER
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW-R
Provider Gender Code:
M

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:
1851362743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24384 NYS RTE 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13601-5012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-772-9807
Provider Business Mailing Address Fax Number:
315-788-3550

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG. T-2228, FT DRUM N.Y.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13602-5004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-8801
Provider Business Practice Location Address Fax Number:
315-772-4097
Provider Enumeration Date:
01/30/2006

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:  R030329-1 , 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)





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