=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639536154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH V. MAROTTA M.ED., M.S.W., LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2016
-----------------------------------------------------
Last Update Date | 01/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3322 ROUTE 22 STE 424
-----------------------------------------------------
City | BRANCHBURG
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08876-3395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-991-5176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 MIMOSA DR
-----------------------------------------------------
City | WHITEHOUSE STATION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08889-3509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-991-5176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SC04797600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------