Healthcare Provider Details

I. General information

NPI: 1093861155
Provider Name (Legal Business Name): MARIE WARCHOL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE BRUNNER LCSW

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 HUDSON STREET HUDSON CENTER
CORNWALL ON HUDSON NY
12520
US

IV. Provider business mailing address

17 VAN ALST ST
NEW PALTZ NY
12561
US

V. Phone/Fax

Practice location:
  • Phone: 845-534-2926
  • Fax: 845-534-3518
Mailing address:
  • Phone: 845-255-7469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number027690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: