MEDICARE: JOHANNES MARSELIS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	082493-1	NY

General Provider Information

NPI Number	:	1114340908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNES MARSELIS LMSW

Provider Business Mailing Address
First Line	:	26 COURT ST
Second Line	:	STE 614
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1106
Country	:	US
Telephone Number	:	347-668-6946
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 COURT ST
Second Line	:	STE 614
City	:	BROOKLYN
State	:	NY
Zip	:	11242-1106
Country	:	US
Telephone Number	:	347-668-6946
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2014
Last Update Date	:	08/18/2016

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