Provider Demographics
NPI:1326321613
Name:MARMOLEJOS, WALESCA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:WALESCA
Middle Name:
Last Name:MARMOLEJOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WILCOX AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1422
Mailing Address - Country:US
Mailing Address - Phone:347-205-0460
Mailing Address - Fax:
Practice Address - Street 1:1115 WILCOX AVE
Practice Address - Street 2:BASEMENT APARTMENT
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1422
Practice Address - Country:US
Practice Address - Phone:347-205-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0847961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical