Provider Demographics
NPI:1154491306
Name:MARKUNAS, GEORGE PATRICK (LCSW)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:PATRICK
Last Name:MARKUNAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 HURLEY AVE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443-5124
Mailing Address - Country:US
Mailing Address - Phone:845-340-4160
Mailing Address - Fax:845-340-4094
Practice Address - Street 1:239 GOLDEN HILL LN
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-6441
Practice Address - Country:US
Practice Address - Phone:845-340-4160
Practice Address - Fax:845-340-4094
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074821-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074821-1OtherLICENSE ID NUMBER
NYN534H1Medicare ID - Type UnspecifiedMEDICARE PROVIDER