Provider Demographics
NPI:1659518009
Name:MARYANNE MUNNELLY, CSW, PC
Entity Type:Organization
Organization Name:MARYANNE MUNNELLY, CSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARYANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:631-476-7141
Mailing Address - Street 1:53 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3314
Mailing Address - Country:US
Mailing Address - Phone:631-476-7141
Mailing Address - Fax:631-476-7665
Practice Address - Street 1:53 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3314
Practice Address - Country:US
Practice Address - Phone:631-476-7141
Practice Address - Fax:631-476-7665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty