Provider Demographics
NPI:1285354241
Name:KADDO MOUAWAD, MARSHA (LMHC)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:KADDO MOUAWAD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WAGER RD
Mailing Address - Street 2:
Mailing Address - City:WYNANTSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12198-3431
Mailing Address - Country:US
Mailing Address - Phone:518-268-9259
Mailing Address - Fax:
Practice Address - Street 1:139 VLY RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-2212
Practice Address - Country:US
Practice Address - Phone:518-608-4271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010093-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health