Provider Demographics
NPI:1124367669
Name:MILLET, MARNI MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARNI
Middle Name:MARIE
Last Name:MILLET
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 1:2018 COURT ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13208-1904
Mailing Address - Country:US
Mailing Address - Phone:315-480-7160
Mailing Address - Fax:
Practice Address - Street 1:4465 E GENESEE ST STE 282
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-2229
Practice Address - Country:US
Practice Address - Phone:315-480-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCASAC-18680101YA0400X
NY72 084761104100000X
NY0846841041C0700X
NY72 0846841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCASAC-18680OtherNEW YORK STATE OFFICE OF ALCOHOL AND SUBSTANCE ABUSE SERVICES
NY72 084684OtherNYS DEPT OF EDUCATION OFFICE OF THE PROFESSIONS
NY72 084761OtherNEW YORK STATE DEPT OF EDUCATION OFFICE OF THE PROFESSIONS