Healthcare Provider Details

I. General information

NPI: 1144280611
Provider Name (Legal Business Name): MARCIA LYNNE WESTRA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 LAFAYETTE ST # 640
NEW YORK NY
10003-7032
US

IV. Provider business mailing address

11 ASHWOOD TER
NEWBURGH NY
12550-2002
US

V. Phone/Fax

Practice location:
  • Phone: 212-228-5856
  • Fax: 845-358-2410
Mailing address:
  • Phone: 845-358-2410
  • Fax: 845-358-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberPR032565-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: