Provider Demographics
NPI:1740584341
Name:IVY MARWIL
Entity Type:Organization
Organization Name:IVY MARWIL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:IVY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARWIL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:401-351-5730
Mailing Address - Street 1:293 GOVERNOR ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3220
Mailing Address - Country:US
Mailing Address - Phone:401-351-5730
Mailing Address - Fax:401-331-6260
Practice Address - Street 1:293 GOVERNOR ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3220
Practice Address - Country:US
Practice Address - Phone:401-351-5730
Practice Address - Fax:401-331-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW006421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty