Provider Demographics
NPI:1245574763
Name:ROSNEL, MARLENA (LISW)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:
Last Name:ROSNEL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 SIYIAN CT
Mailing Address - Street 2:
Mailing Address - City:COCHITI LAKE
Mailing Address - State:NM
Mailing Address - Zip Code:87083-6008
Mailing Address - Country:US
Mailing Address - Phone:505-345-5529
Mailing Address - Fax:505-345-2211
Practice Address - Street 1:6121 INDIAN SCHOOL RD NE STE 103
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4165
Practice Address - Country:US
Practice Address - Phone:505-345-5529
Practice Address - Fax:505-345-2211
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-07941101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health