Provider Demographics
NPI:1053939702
Name:PETION, MARIE GUIRLENE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:GUIRLENE
Last Name:PETION
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2434
Mailing Address - Country:US
Mailing Address - Phone:302-943-0265
Mailing Address - Fax:
Practice Address - Street 1:292 CARTER DR STE A&B
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5846
Practice Address - Country:US
Practice Address - Phone:302-257-5848
Practice Address - Fax:302-397-2068
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ3-000126104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker