Provider Demographics
NPI:1144280611
Name:WESTRA, MARCIA LYNNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:LYNNE
Last Name:WESTRA
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 1:11 ASHWOOD TER
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2002
Mailing Address - Country:US
Mailing Address - Phone:845-358-2410
Mailing Address - Fax:845-358-2410
Practice Address - Street 1:411 LAFAYETTE ST # 640
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-7032
Practice Address - Country:US
Practice Address - Phone:212-228-5856
Practice Address - Fax:845-358-2410
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR032565-21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080435OtherVALUE OPTIONS
NY02091752Medicaid
NY02091752Medicaid
NY02091752Medicaid
NY080435OtherVALUE OPTIONS