Provider Demographics
NPI:1104109008
Name:JUNIOR, MARCIA PATRICIA
Entity type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:PATRICIA
Last Name:JUNIOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-6018
Mailing Address - Country:US
Mailing Address - Phone:718-379-7788
Mailing Address - Fax:
Practice Address - Street 1:3601 PALMER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-6018
Practice Address - Country:US
Practice Address - Phone:718-379-7788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084159-1104100000X
NY21619181041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool