Provider Demographics
NPI:1922286830
Name:MENIFEE, MARLENE (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MISS
First Name:MARLENE
Middle Name:
Last Name:MENIFEE
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 WEST END AVENUE
Mailing Address - Street 2:#12D
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6144
Mailing Address - Country:US
Mailing Address - Phone:212-362-5020
Mailing Address - Fax:
Practice Address - Street 1:140 WEST END AVENUE
Practice Address - Street 2:#12D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6144
Practice Address - Country:US
Practice Address - Phone:212-362-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR00049911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN06961Medicare PIN