Provider Demographics
NPI:1942464938
Name:GRESH, MARILYN B (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:B
Last Name:GRESH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:LANOKA HARBOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08734-0537
Mailing Address - Country:US
Mailing Address - Phone:609-242-4061
Mailing Address - Fax:609-693-2789
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:LANLAC BLDG 1 - SUITE 4 - 2ND FLOOR
Practice Address - City:LANOKA HARBOR
Practice Address - State:NJ
Practice Address - Zip Code:08734-2228
Practice Address - Country:US
Practice Address - Phone:609-242-4061
Practice Address - Fax:609-693-2789
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054129001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical