Healthcare Provider Details

I. General information

NPI: 1598310120
Provider Name (Legal Business Name): MARLEE ELIZABETH FICKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 08/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD ORANGEBURG RD
ORANGEBURG NY
10962-1157
US

IV. Provider business mailing address

51 GRANDVIEW AVE
NANUET NY
10954-2511
US

V. Phone/Fax

Practice location:
  • Phone: 845-398-7053
  • Fax: 845-680-5560
Mailing address:
  • Phone: 845-826-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075450-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: