Provider Demographics
NPI:1194392027
Name:MARLENE SMALL LCSW PC
Entity Type:Organization
Organization Name:MARLENE SMALL LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:337-242-7469
Mailing Address - Street 1:6750 THORNTON PL APT 2G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4180
Mailing Address - Country:US
Mailing Address - Phone:337-242-7469
Mailing Address - Fax:518-677-1803
Practice Address - Street 1:6750 THORNTON PL APT 2G
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4180
Practice Address - Country:US
Practice Address - Phone:337-242-7469
Practice Address - Fax:254-613-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty