Provider Demographics
NPI:1821078361
Name:REMBERT, MARYLEE WILLIAMSON (MSW,ACSW,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARYLEE
Middle Name:WILLIAMSON
Last Name:REMBERT
Suffix:
Gender:F
Credentials:MSW,ACSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5509B W FRIENDLY AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4270
Mailing Address - Country:US
Mailing Address - Phone:336-272-0855
Mailing Address - Fax:336-272-9885
Practice Address - Street 1:5509B W FRIENDLY AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4270
Practice Address - Country:US
Practice Address - Phone:336-272-0855
Practice Address - Fax:336-272-9885
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0001501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2867526Medicare ID - Type Unspecified