| Doctor Name: | MS. SANDRA ANN MARNELL |
| NPI Number: | 1063772721 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA |
| License Number: | 3648 |
| Business Practice Address: | 11-21 Broadway St Gloversville, NY - 120783968 |
| Business Phone Number: | 5187254310 |
| Business Fax Number: | 5187253116 |
| Mailing Address: | 11-21 Broadway St, GLOVERSVILLE |
| State: | NY |
| Postal Code: | 120783968 |
| Phone Number: | 5187254310 |
| Fax Number: | 5187253116 |
| NPI Enumeration Date: | 05/29/2012 |
| NPI Last Update Date: | 05/29/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 3648 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |