Provider Demographics
NPI:1326746405
Name:JUAREZ, MARIEL AYDEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIEL
Middle Name:AYDEE
Last Name:JUAREZ
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 1:500 SAINT MARKS AVE APT 310
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-3990
Mailing Address - Country:US
Mailing Address - Phone:917-627-8878
Mailing Address - Fax:
Practice Address - Street 1:25 CHAPEL ST STE 604
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1916
Practice Address - Country:US
Practice Address - Phone:347-419-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0817301041C0700X
NY084104-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty