MEDICARE: MS. MARILYN YOUNG MENDENHALL LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	001536	NY

General Provider Information

NPI Number	:	1134337884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN YOUNG MENDENHALL LMHC

Provider Business Mailing Address
First Line	:	PO BOX 546
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-0546
Country	:	US
Telephone Number	:	845-350-1040
Fax Number	:

Provider Business Practice Location Address
First Line	:	1285 ROUTE 9
Second Line	:	SUITE # 7
City	:	WAPPINGERS FALLS
State	:	NY
Zip	:	12590-4993
Country	:	US
Telephone Number	:	845-632-2939
Fax Number	:	845-632-2940

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	11/07/2012

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