| Marian Susan Sanborn Lcsw Pllc | |
|
136 Jersey Ave Port Jervis NY 12771-2611 | |
| (845) 328-0133 | |
| Not Available |
| Full Name | Marian Susan Sanborn Lcsw Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 136 Jersey Ave, Port Jervis, New York |
| Authorized Official Name and Position | Nicole Saborn (INSURANCE COORDINATOR) |
| Authorized Official Contact | 5709946920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Marian Susan Sanborn Lcsw Pllc 700 Avenue M Matamoras PA 18336-1811 Ph: (845) 328-0133 | Marian Susan Sanborn Lcsw Pllc 136 Jersey Ave Port Jervis NY 12771-2611 Ph: (845) 328-0133 |
| NPI Number | 1508548744 |
|---|---|
| Provider Enumeration Date | 08/07/2023 |
| Last Update Date | 12/22/2023 |
| Certification Date | 12/22/2023 |
| Medicare PECOS PAC ID | 0547791782 |
|---|---|
| Medicare Enrollment ID | O20240930001143 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508548744 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Marian Sanborn |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609384429 PECOS PAC ID: 1557741386 Enrollment ID: I20220711000538 |
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