Healthcare Provider Details

I. General information

NPI: 1821810706
Provider Name (Legal Business Name): VINCENT MARCIANO LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 W 15TH ST FL 5
NEW YORK NY
10011-6701
US

IV. Provider business mailing address

145 W 15TH ST FL 2
NEW YORK NY
10011-6701
US

V. Phone/Fax

Practice location:
  • Phone: 212-229-6905
  • Fax:
Mailing address:
  • Phone: 212-924-6320
  • Fax: 646-306-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number124398
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: