Healthcare Provider Details

I. General information

NPI: 1437920022
Provider Name (Legal Business Name): MARCY RULAND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARCY BREE RULAND LCSW

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PAVLUS LN
FONDA NY
12068-5949
US

IV. Provider business mailing address

125 PAVLUS LN
FONDA NY
12068-5949
US

V. Phone/Fax

Practice location:
  • Phone: 518-331-9325
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number102890
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19013
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: