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NPI Code Detail

MEDICARE: MS. MARJORIE PHYLLIS DRIAN LCSW

MEDICARE: MS. MARJORIE PHYLLIS DRIAN 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
11041C0700XClinical Social Worker077859NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821086604
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARJORIE PHYLLIS DRIAN LCSW
Provider Business Mailing Address
First Line : 146 PIKE ST
Second Line :
City : PORT JERVIS
State : NY
Zip : 12771-1808
Country : US
Telephone Number : 845-858-1456
Fax Number : 845-858-1459
Provider Business Practice Location Address
First Line : 146 PIKE ST
Second Line :
City : PORT JERVIS
State : NY
Zip : 12771-1808
Country : US
Telephone Number : 845-858-1456
Fax Number : 845-858-1459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 09/25/2013

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