Provider Demographics
NPI:1174693147
Name:MARSCHKE, JACINTA LU (PHD, LICSW)
Entity type:Individual
Prefix:DR
First Name:JACINTA
Middle Name:LU
Last Name:MARSCHKE
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 MAIN ST
Mailing Address - Street 2:#70
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1325
Mailing Address - Country:US
Mailing Address - Phone:845-255-5466
Mailing Address - Fax:
Practice Address - Street 1:243 MAIN ST
Practice Address - Street 2:#70
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1325
Practice Address - Country:US
Practice Address - Phone:845-255-5466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01940858Medicaid
NY01940858Medicaid