Provider Demographics
NPI:1275288524
Name:MARRERO, KIMMBERLY
Entity Type:Individual
Prefix:
First Name:KIMMBERLY
Middle Name:
Last Name:MARRERO
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 1:39 CHAPEL HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1901
Mailing Address - Country:US
Mailing Address - Phone:631-871-3134
Mailing Address - Fax:
Practice Address - Street 1:39 CHAPEL HILL DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1901
Practice Address - Country:US
Practice Address - Phone:631-871-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool