Provider Demographics
NPI:1073601936
Name:JENNINGS, MARILENA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILENA
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARILENA
Other - Middle Name:D
Other - Last Name:JENNINGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2926 LASALLE AVE
Mailing Address - Street 2:FL-1
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-5906
Mailing Address - Country:US
Mailing Address - Phone:347-398-9179
Mailing Address - Fax:347-398-9179
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:FITH FLOOR CHILD AND ADOLESCENT PSYCHIATRY SERVICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-466-7281
Practice Address - Fax:718-466-7288
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225942-12084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry