Provider Demographics
NPI:1912107913
Name:SYKES, MARILYN (CASAC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:SYKES
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:SYKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:80 GOODRICH ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203-1005
Mailing Address - Country:US
Mailing Address - Phone:716-859-2133
Mailing Address - Fax:716-859-2560
Practice Address - Street 1:80 GOODRICH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1005
Practice Address - Country:US
Practice Address - Phone:716-859-2133
Practice Address - Fax:716-859-2560
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18662101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health