Provider Demographics
NPI:1013188390
Name:GRENNAN, MARIANNA ZARA (LCSW R)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:ZARA
Last Name:GRENNAN
Suffix:
Gender:F
Credentials:LCSW R
Other - Prefix:
Other - First Name:MARIANNA
Other - Middle Name:
Other - Last Name:ZARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:11 WINDHAM DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-271-5617
Mailing Address - Fax:631-385-1776
Practice Address - Street 1:900 WALT WHITMAN ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-271-5617
Practice Address - Fax:631-385-1776
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0493851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical