Provider Demographics
NPI:1396872875
Name:DEMARSE, RICKY (LCSW)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:DEMARSE
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 1:851 COUNTY ROUTE 12
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958-4510
Mailing Address - Country:US
Mailing Address - Phone:845-355-8647
Mailing Address - Fax:
Practice Address - Street 1:210 E MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4038
Practice Address - Country:US
Practice Address - Phone:845-820-8656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY568231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical