Provider Demographics
NPI:1447508908
Name:MARSTON, MARYANN (LCSW)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:MARSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 PARK AVENUE
Mailing Address - Street 2:6B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7343
Mailing Address - Country:US
Mailing Address - Phone:212-371-3345
Mailing Address - Fax:212-371-1679
Practice Address - Street 1:20 EAST 68 STREET
Practice Address - Street 2:SUITE 203
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5836
Practice Address - Country:US
Practice Address - Phone:917-444-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
102L00000X, 172V00000X
NY087049-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No172V00000XOther Service ProvidersCommunity Health Worker