Provider Demographics
NPI:1902507510
Name:SIEGEL-TUCH, MARNI JOY (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:JOY
Last Name:SIEGEL-TUCH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 SALEM LN
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-4334
Mailing Address - Country:US
Mailing Address - Phone:516-503-3721
Mailing Address - Fax:
Practice Address - Street 1:24 SALEM LN
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-4334
Practice Address - Country:US
Practice Address - Phone:516-503-3721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-13
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0547581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical