Provider Demographics
NPI:1588642649
Name:SUKIENNIK, MARLENE BELMONT (LCSW, ACSW)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:BELMONT
Last Name:SUKIENNIK
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W WIEUCA NERD 140
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3369
Mailing Address - Country:US
Mailing Address - Phone:678-720-8921
Mailing Address - Fax:404-254-2031
Practice Address - Street 1:10601 N HAYDEN RD
Practice Address - Street 2:# I-108
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5687
Practice Address - Country:US
Practice Address - Phone:602-938-3323
Practice Address - Fax:602-938-1626
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-08
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6721041C0700X
NE4751041C0700X
AZ127241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ129124Medicare PIN
NE273418Medicare PIN