Provider Demographics
NPI:1922711308
Name:MARMOLEJOS, JOCELYNN MIA (LMSW)
Entity Type:Individual
Prefix:
First Name:JOCELYNN
Middle Name:MIA
Last Name:MARMOLEJOS
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 1:22 E 112TH ST APT 422
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-2646
Mailing Address - Country:US
Mailing Address - Phone:212-920-0229
Mailing Address - Fax:
Practice Address - Street 1:22 E 112TH ST APT 422
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-2646
Practice Address - Country:US
Practice Address - Phone:212-920-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2023-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116451104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker