Healthcare Provider Details

I. General information

NPI: 1780734210
Provider Name (Legal Business Name): MARI L WARFEL LCSW-R, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 OLD STORY ROAD
LEEDS NY
12451-1216
US

IV. Provider business mailing address

128 OLD STORY ROAD
LEEDS NY
12451-1216
US

V. Phone/Fax

Practice location:
  • Phone: 518-618-8868
  • Fax:
Mailing address:
  • Phone: 518-618-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number052197-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: