Healthcare Provider Details

I. General information

NPI: 1720306434
Provider Name (Legal Business Name): AIMEE LEE MARSTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ESSEX STREET SUITE 206
HACKENSACK NJ
07601-4035
US

IV. Provider business mailing address

75 ESSEX STREET SUITE 206
HACKENSACK NJ
07601-4035
US

V. Phone/Fax

Practice location:
  • Phone: 973-626-3777
  • Fax:
Mailing address:
  • Phone: 973-626-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05215200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: