Provider Demographics
NPI:1043984347
Name:BEDNAREK, MARINA TAYLOR (MA, LAC)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:TAYLOR
Last Name:BEDNAREK
Suffix:
Gender:F
Credentials:MA, LAC
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:TAYLOR
Other - Last Name:BEDNAREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 HADDONTOWNE CT
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-3602
Mailing Address - Country:US
Mailing Address - Phone:609-566-8607
Mailing Address - Fax:
Practice Address - Street 1:100 HADDONTOWNE CT
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3602
Practice Address - Country:US
Practice Address - Phone:609-566-8607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-02
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00588300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty