Provider Demographics
NPI:1942426127
Name:PUGLIESE, MARILYN S (MSW)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:S
Last Name:PUGLIESE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15641 ROBINSON RD
Mailing Address - Street 2:PO BOX 55
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-9030
Mailing Address - Country:US
Mailing Address - Phone:614-873-5097
Mailing Address - Fax:614-873-5662
Practice Address - Street 1:3021 BETHEL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2286
Practice Address - Country:US
Practice Address - Phone:614-457-3281
Practice Address - Fax:614-457-3281
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI35951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical