Provider Demographics
NPI:1356330872
Name:AUSTIN, MARILYN ANSEVIN (PHD,LCSW-C, BCD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ANSEVIN
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD,LCSW-C, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19345 OLNEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1101
Mailing Address - Country:US
Mailing Address - Phone:301-570-9143
Mailing Address - Fax:
Practice Address - Street 1:19345 OLNEY MILL RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1101
Practice Address - Country:US
Practice Address - Phone:301-570-9143
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical