MEDICARE: MISS VALERIE MARCKETTA 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	1041C0700X	Clinical Social Worker	44SC00490200	NJ

General Provider Information

NPI Number	:	1902986631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS VALERIE MARCKETTA LCSW

Provider Business Mailing Address
First Line	:	18 MEEKER PL
Second Line	:
City	:	MILLBURN
State	:	NJ
Zip	:	07041-1108
Country	:	US
Telephone Number	:	973-376-0706
Fax Number	:

Provider Business Practice Location Address
First Line	:	567 PARK AVE
Second Line	:	204
City	:	SCOTCH PLAINS
State	:	NJ
Zip	:	07076-1754
Country	:	US
Telephone Number	:	908-322-0112
Fax Number	:	908-789-0230

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	11/05/2007

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