Provider Demographics
NPI:1972974095
Name:HINESTROZA GAVIRIA, MARLY A (MSW)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:A
Last Name:HINESTROZA GAVIRIA
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 1:2801 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2838
Mailing Address - Country:US
Mailing Address - Phone:252-670-1683
Mailing Address - Fax:
Practice Address - Street 1:2801 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2838
Practice Address - Country:US
Practice Address - Phone:252-670-1683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health