MEDICARE: MS. MARCY KNIFFIN LCSW

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	1041C0700X	Clinical Social Worker	R041537-1	NY

General Provider Information

NPI Number	:	1154416832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCY KNIFFIN LCSW

Provider Business Mailing Address
First Line	:	18 NORTH ST
Second Line	:
City	:	PATTERSON
State	:	NY
Zip	:	12563-2710
Country	:	US
Telephone Number	:	845-309-4571
Fax Number	:	845-223-5350

Provider Business Practice Location Address
First Line	:	1591 ROUTE 22
Second Line	:	C/O WHOLISTIC PHYSICAL THERAPY
City	:	BREWSTER
State	:	NY
Zip	:	10509-4026
Country	:	US
Telephone Number	:	845-309-4571
Fax Number	:	845-940-1051

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/31/2008

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