Provider Demographics
NPI:1912573544
Name:STUART, MARLENA S (LMSW)
Entity Type:Individual
Prefix:
First Name:MARLENA
Middle Name:S
Last Name:STUART
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARLENA
Other - Middle Name:STUART
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 S. NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807
Mailing Address - Country:US
Mailing Address - Phone:417-269-8817
Mailing Address - Fax:
Practice Address - Street 1:3800 S. NATIONAL AVE, 7TH FLOOR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807
Practice Address - Country:US
Practice Address - Phone:417-269-8817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210084721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical