Individual
MARILYN BRYAN DEBERNARDO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMHC, CASAC-G
Contact information
Practice address
4 TECHNICAL PARK, SUITE #3, #6, GLENS FALLS, NY 12801
(518) 847-7803
(518) 280-5049
Mailing address
97 DUNSBACH PD, CLIFTON PARK, NY 12065
(518) 847-7803
(518) 280-5049
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
002250-1
NY
101YA0400X
Addiction (Substance Use Disorder) Counselor
11051
NY
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
11051
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420800
—
NY
Enumeration date
06/30/2008
Last updated
06/12/2023
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