Healthcare Provider Details

I. General information

NPI: 1982971453
Provider Name (Legal Business Name): PHYLLIS A. MARTON MA, LMHC, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 NORTH ST
KATONAH NY
10536-1521
US

IV. Provider business mailing address

24 NORTH ST
KATONAH NY
10536-1521
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-7217
  • Fax:
Mailing address:
  • Phone: 914-232-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP79744
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005351-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002232
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: