Healthcare Provider Details

I. General information

NPI: 1720552326
Provider Name (Legal Business Name): MARJETA KANE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S 40TH ST STE 201B
PHILADELPHIA PA
19104-5827
US

IV. Provider business mailing address

3043 STATE ROUTE 4
HUDSON FALLS NY
12839-9632
US

V. Phone/Fax

Practice location:
  • Phone: 855-675-4010
  • Fax: 617-807-0958
Mailing address:
  • Phone: 518-747-2284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number093282-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024480
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: