Provider Demographics
NPI:1134460595
Name:LAJARA-OTTLEY, MARELLYN (LMHC)
Entity Type:Individual
Prefix:
First Name:MARELLYN
Middle Name:
Last Name:LAJARA-OTTLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARELLYN
Other - Middle Name:
Other - Last Name:LAJARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHC
Mailing Address - Street 1:102 PILLING STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207
Mailing Address - Country:US
Mailing Address - Phone:646-244-5832
Mailing Address - Fax:
Practice Address - Street 1:102 PILLING STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207
Practice Address - Country:US
Practice Address - Phone:718-602-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health