Provider Demographics
NPI:1851477400
Name:SMALL, MARLENE (LCSW)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:SMALL
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 1:6750 THORNTON PL APT 2G
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4180
Mailing Address - Country:US
Mailing Address - Phone:337-242-7469
Mailing Address - Fax:518-677-1803
Practice Address - Street 1:6750 THORNTON PL
Practice Address - Street 2:APT 2G
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4180
Practice Address - Country:US
Practice Address - Phone:337-242-7469
Practice Address - Fax:254-613-4515
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9902TGMedicare ID - Type Unspecified