Provider Demographics
NPI:1639183403
Name:GENSLER, MARILYN W (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:W
Last Name:GENSLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:W
Other - Last Name:GENSLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:4727 REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-3168
Mailing Address - Country:US
Mailing Address - Phone:225-924-0123
Mailing Address - Fax:225-924-5455
Practice Address - Street 1:4727 REVERE AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-3168
Practice Address - Country:US
Practice Address - Phone:225-924-0123
Practice Address - Fax:225-924-5455
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3481101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA3481OtherSTATE SOCIAL WK. LICENSE