Provider Demographics
NPI:1255578621
Name:STANTON, MARNIE A (LCSW)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:A
Last Name:STANTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARNIE
Other - Middle Name:A
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 101854
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-0854
Mailing Address - Country:US
Mailing Address - Phone:412-440-8797
Mailing Address - Fax:
Practice Address - Street 1:416 FOX DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3606
Practice Address - Country:US
Practice Address - Phone:412-440-8797
Practice Address - Fax:412-312-3005
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI10001201041C0700X
PACW0162351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3059103Medicaid
OH2033701Medicare PIN