Provider Demographics
NPI:1659695542
Name:WEST, MARIANNE V (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:V
Last Name:WEST
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 WOODLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-1950
Mailing Address - Country:US
Mailing Address - Phone:574-286-4068
Mailing Address - Fax:574-271-3740
Practice Address - Street 1:219 N DIXIE WAY STE 135
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3372
Practice Address - Country:US
Practice Address - Phone:574-286-4068
Practice Address - Fax:574-271-3740
Is Sole Proprietor?:No
Enumeration Date:2010-03-21
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000189A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical