Provider Demographics
NPI:1508295270
Name:MARRERO, MIGUEL (DCW)
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:
Last Name:MARRERO
Suffix:
Gender:M
Credentials:DCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 E 96TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3805
Mailing Address - Country:US
Mailing Address - Phone:212-828-8500
Mailing Address - Fax:212-828-8600
Practice Address - Street 1:336 E 96TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3805
Practice Address - Country:US
Practice Address - Phone:212-828-8500
Practice Address - Fax:212-828-8600
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health