Provider Demographics
NPI:1689639379
Name:SLAVIN, MARJORIE A (MSW LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:A
Last Name:SLAVIN
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 1:401 W 259TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471
Mailing Address - Country:US
Mailing Address - Phone:718-601-0327
Mailing Address - Fax:718-548-7977
Practice Address - Street 1:401 W 259TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471
Practice Address - Country:US
Practice Address - Phone:718-601-0327
Practice Address - Fax:718-548-7977
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0137771106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P3383898OtherOXFORD
3125633OtherAETNA
0040900OtherGHI
4323398OtherAETNA HMO
144832OtherVALUE OPTIONS
2085679OtherCIGNA
N07832Medicare ID - Type Unspecified