MEDICARE: KATHLEEN DE MARSE

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	112873	NY

General Provider Information

NPI Number	:	1881446862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN DE MARSE

Provider Business Mailing Address
First Line	:	62 PARK TER W
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-1306
Country	:	US
Telephone Number	:	917-557-0278
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 WASHINGTON AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10456-6688
Country	:	US
Telephone Number	:	917-557-0278
Fax Number	:

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

Provider Enumeration Date	:	04/03/2024
Last Update Date	:	04/03/2024

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Directions to “ KATHLEEN DE MARSE ” Practice Location

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