Healthcare Provider Details

I. General information

NPI: 1275214447
Provider Name (Legal Business Name): MARYAM EDUN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 STEELE CIR
NIAGARA FALLS NY
14304-1120
US

IV. Provider business mailing address

73 STEELE CIR
NIAGARA FALLS NY
14304-1120
US

V. Phone/Fax

Practice location:
  • Phone: 703-851-0627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number120500
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: