Provider Demographics
NPI:1205476728
Name:SEMINARIO, MARLENA JAMIE
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:JAMIE
Last Name:SEMINARIO
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 1:24 ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2910
Mailing Address - Country:US
Mailing Address - Phone:516-455-5611
Mailing Address - Fax:
Practice Address - Street 1:24 ELLEN ST
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-2910
Practice Address - Country:US
Practice Address - Phone:516-455-5611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054968104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker