Healthcare Provider Details

I. General information

NPI: 1780173336
Provider Name (Legal Business Name): KATHERINE MARMOL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 DEPEW ST
PEEKSKILL NY
10566-5502
US

IV. Provider business mailing address

845 N BROADWAY
WHITE PLAINS NY
10603-2403
US

V. Phone/Fax

Practice location:
  • Phone: 914-734-1359
  • Fax:
Mailing address:
  • Phone: 914-761-0600
  • Fax: 914-761-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number119213
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: