Provider Demographics
NPI:1700052347
Name:BAHARI, MARILYNN SMITH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARILYNN
Middle Name:SMITH
Last Name:BAHARI
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 1:1115 TURTLE CREEK DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-3673
Mailing Address - Country:US
Mailing Address - Phone:904-696-3975
Mailing Address - Fax:
Practice Address - Street 1:1115 TURTLE CREEK DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-3673
Practice Address - Country:US
Practice Address - Phone:904-696-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-04
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW36401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical