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NPI Code Detail

MEDICARE: MARCIA N DOUGLAS LCSW R

MEDICARE: MARCIA N DOUGLAS LCSW R
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
1101YM0800XMental Health Counselor052112NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265474381
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARCIA N DOUGLAS LCSW R
Provider Business Mailing Address
First Line : 272 S LHOMMEDIEU ST
Second Line :
City : MONTOUR FALLS
State : NY
Zip : 14865-9786
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 106 S PERRY ST
Second Line : STE 4
City : WATKINS GLEN
State : NY
Zip : 14891-1615
Country : US
Telephone Number : 607-535-8282
Fax Number : 607-535-8284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 07/08/2007

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1245271956 — DIANE JORGENSEN SCHMIDT LCSW
Practice Location Address:
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Directions to “ MARCIA N DOUGLAS LCSW R” Practice Location

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