Provider Demographics
NPI:1326052366
Name:MARWIL, IVY GALE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:IVY
Middle Name:GALE
Last Name:MARWIL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:293 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3220
Mailing Address - Country:US
Mailing Address - Phone:401-351-5730
Mailing Address - Fax:401-331-6260
Practice Address - Street 1:293 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3220
Practice Address - Country:US
Practice Address - Phone:401-351-5730
Practice Address - Fax:401-331-6260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW006421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9400-9OtherBLUE CROSS
MA758586OtherTUFTS