Provider Demographics
NPI:1295483188
Name:WHITLEY, MARSHA (LCSW)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:WHITLEY
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 1:96 SPRUCEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1430
Mailing Address - Country:US
Mailing Address - Phone:315-952-1084
Mailing Address - Fax:
Practice Address - Street 1:96 SPRUCEWOOD CIR
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1430
Practice Address - Country:US
Practice Address - Phone:315-952-1084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
NY104100000X
NY0924231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker