MEDICARE: MARYANN MARSTON LCSW

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	102L00000X	Psychoanalyst
2	172V00000X	Community Health Worker
3	104100000X	Social Worker	087049-1	NY

General Provider Information

NPI Number	:	1447508908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN MARSTON LCSW

Provider Business Mailing Address
First Line	:	570 PARK AVENUE
Second Line	:	6B
City	:	NEW YORK
State	:	NY
Zip	:	10065-7343
Country	:	US
Telephone Number	:	212-371-3345
Fax Number	:	212-371-1679

Provider Business Practice Location Address
First Line	:	20 EAST 68 STREET
Second Line	:	SUITE 203
City	:	NEW YORK
State	:	NY
Zip	:	10065-5836
Country	:	US
Telephone Number	:	917-444-3371
Fax Number	:

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	02/26/2020

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