Provider Demographics
NPI:1891303483
Name:MARVIN, DANIELLE ANNETTE (LMSW)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ANNETTE
Last Name:MARVIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 MCREE AVE # A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2617
Mailing Address - Country:US
Mailing Address - Phone:563-293-0059
Mailing Address - Fax:
Practice Address - Street 1:3633 MCREE AVE # A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2617
Practice Address - Country:US
Practice Address - Phone:563-293-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020018026104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker