Provider Demographics
NPI:1760820369
Name:POPKO, MARILYN KLOCK (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:KLOCK
Last Name:POPKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:KLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA, BSW, MA, MSW
Mailing Address - Street 1:7901 SW 67TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4538
Mailing Address - Country:US
Mailing Address - Phone:305-668-1777
Mailing Address - Fax:786-899-0955
Practice Address - Street 1:7901 SW 67TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4538
Practice Address - Country:US
Practice Address - Phone:305-668-1777
Practice Address - Fax:786-899-0955
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00026651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical