=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548284789
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HILARY MARSHAK MSW, LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2006
-----------------------------------------------------
Last Update Date | 09/10/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 E 12TH ST SUITE 2A-F
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10003-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-349-0011
-----------------------------------------------------
Fax | 212-691-6600
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 75 MONTGOMERY ST APT 7C
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10002-6553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-349-0011
-----------------------------------------------------
Fax | 212-349-0011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | R044859-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------