Provider Demographics
NPI:1447270913
Name:ONTELL, MARSHA K (MSW, LCSW, DCSW)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:K
Last Name:ONTELL
Suffix:
Gender:F
Credentials:MSW, LCSW, DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 MAGNOLIA PL
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1708
Mailing Address - Country:US
Mailing Address - Phone:201-592-6628
Mailing Address - Fax:
Practice Address - Street 1:325 MAGNOLIA PL
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-1708
Practice Address - Country:US
Practice Address - Phone:201-592-6628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC010178001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071336Medicare ID - Type Unspecified