Provider Demographics
NPI:1063400315
Name:PAUL, MARILYN S (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:S
Last Name:PAUL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LYN
Other - Middle Name:S
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:75 CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-1503
Mailing Address - Country:US
Mailing Address - Phone:516-625-0930
Mailing Address - Fax:516-621-7164
Practice Address - Street 1:333 E SHORE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-2900
Practice Address - Country:US
Practice Address - Phone:516-625-0939
Practice Address - Fax:516-621-7164
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRP0520421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical