Provider Demographics
NPI:1033274360
Name:WELLINGTON, MARLENE ELAINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:ELAINE
Last Name:WELLINGTON
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 1:880 NE 69TH ST APT 5M
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-5748
Mailing Address - Country:US
Mailing Address - Phone:305-756-6688
Mailing Address - Fax:305-757-1718
Practice Address - Street 1:880 NE 69TH ST APT 5M
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5748
Practice Address - Country:US
Practice Address - Phone:305-756-6688
Practice Address - Fax:305-757-1718
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2420101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2420OtherCLINICAL SOCIAL WORK