Provider Demographics
NPI:1619950268
Name:KISIEL, MARILYN CATHARINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:CATHARINE
Last Name:KISIEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 SEA PINES CIR E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3007
Mailing Address - Country:US
Mailing Address - Phone:727-724-1965
Mailing Address - Fax:727-239-7765
Practice Address - Street 1:2748 SEA PINES CIR E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3007
Practice Address - Country:US
Practice Address - Phone:727-724-1965
Practice Address - Fax:727-239-7765
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 15341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5964Medicare ID - Type Unspecified