Healthcare Provider Details

I. General information

NPI: 1063855930
Provider Name (Legal Business Name): STEPHANIE ANNE MARREN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST
ONEIDA NY
13421-2111
US

IV. Provider business mailing address

201 CEDAR ST
ONEIDA NY
13421-2111
US

V. Phone/Fax

Practice location:
  • Phone: 315-280-0400
  • Fax: 315-280-0087
Mailing address:
  • Phone: 315-280-0400
  • Fax: 315-280-0087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number087671-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: