Provider Demographics
NPI:1427064633
Name:MARK, HELEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:HELEN
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:HELEN
Other - Middle Name:A
Other - Last Name:MARK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:233 LAFAYETTE AVE
Mailing Address - Street 2:SUITE LL4
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4821
Mailing Address - Country:US
Mailing Address - Phone:845-369-3416
Mailing Address - Fax:845-290-9845
Practice Address - Street 1:233 LAFAYETTE AVE
Practice Address - Street 2:SUITE LL4
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4821
Practice Address - Country:US
Practice Address - Phone:845-369-3416
Practice Address - Fax:845-290-9845
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0736601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN6H551Medicare ID - Type Unspecified