Provider Demographics
NPI:1346599487
Name:WILENSKY, MARI (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:
Last Name:WILENSKY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 W KENNEDY BLVD STE 327
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2257
Mailing Address - Country:US
Mailing Address - Phone:727-871-3534
Mailing Address - Fax:
Practice Address - Street 1:4100 W KENNEDY BLVD STE 327
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2257
Practice Address - Country:US
Practice Address - Phone:727-871-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 107391041C0700X
1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool