Provider Demographics
NPI:1982736534
Name:STUCKLE, MARJORIE ANNE (PHD)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANNE
Last Name:STUCKLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W END AVE
Mailing Address - Street 2:16B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6131
Mailing Address - Country:US
Mailing Address - Phone:212-877-4199
Mailing Address - Fax:
Practice Address - Street 1:140 W END AVE
Practice Address - Street 2:16B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6131
Practice Address - Country:US
Practice Address - Phone:212-877-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO18709-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical