Provider Demographics
NPI:1548633506
Name:GORLYN, MARIANNE
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:GORLYN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SUTTON PL S
Mailing Address - Street 2:#1CN
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 SUTTON PL S
Practice Address - Street 2:#1CN
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4168
Practice Address - Country:US
Practice Address - Phone:212-751-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016100103TC0700X
NJ51930103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical