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General NPI Number Information
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NPI Number | 1841736584
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Entity Type | Organization
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Legal Business Name | MARILYNNE SOMMERS, PRIVATE PRACTICE
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Dates
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Enumeration Date | 01/18/2017
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 617 N CAYUGA ST
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City | ITHACA
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State | NY
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Zip | 14850-3607
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Country | US
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Telephone | 607-592-2725
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Fax |
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Provider Business Mailing Address
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Address Line | 930 CODDINGTON RD
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City | ITHACA
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State | NY
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Zip | 14850-6022
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Country | US
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Telephone | 607-592-2725
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. MARILYNNE SOMMERS
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Credential | LCSW
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Telephone | 607-592-2725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R072817-1
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License Number State | NY
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