Provider Demographics
NPI:1417401860
Name:LOUIS, MARIE F
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:F
Last Name:LOUIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 MANHATTAN AVE
Mailing Address - Street 2:APT. 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2720
Mailing Address - Country:US
Mailing Address - Phone:646-853-1272
Mailing Address - Fax:
Practice Address - Street 1:312 MANHATTAN AVE
Practice Address - Street 2:APT. 1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2720
Practice Address - Country:US
Practice Address - Phone:646-853-1272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-14
Last Update Date:2016-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY093203-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker