MEDICARE: MS. MARILYN V URRAYA LCSW, CASAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10873	NY
2	1041C0700X	Clinical Social Worker	R044780	NY

General Provider Information

NPI Number	:	1356283295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN V URRAYA LCSW, CASAC

Provider Business Mailing Address
First Line	:	52-40 39TH DRIVE WOODSIDE N.Y. 11377
Second Line	:	SUITE 1C
City	:	WOODSIDE
State	:	NY
Zip	:	11377-4027
Country	:	US
Telephone Number	:	347-924-4563
Fax Number	:

Provider Business Practice Location Address
First Line	:	52-40 39TH DRIVE WOODSIDE N.Y. 11377
Second Line	:	SUITE 1C
City	:	WOODSIDE
State	:	NY
Zip	:	11377-4027
Country	:	US
Telephone Number	:	347-924-4563
Fax Number	:

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

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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