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General NPI Number Information
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NPI Number | 1851362743
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Entity Type | Individual
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Provider Name | RALPH KIRSCHNER MARCELLUS MSW, LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | BLDG. T-2228, FT DRUM N.Y.
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City | FORT DRUM
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State | NY
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Zip | 13602-5004
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Country | US
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Telephone | 315-772-8801
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Fax | 315-772-4097
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Provider Business Mailing Address
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Address Line | 24384 NYS RTE 12
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City | WATERTOWN
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State | NY
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Zip | 13601-5012
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Country | US
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Telephone | 315-772-9807
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Fax | 315-788-3550
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | R030329-1
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License Number State | NY
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