Provider Demographics
NPI:1295986719
Name:MARRO, JACLYN BETH (LCSW-R, CASAC)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:BETH
Last Name:MARRO
Suffix:
Gender:F
Credentials:LCSW-R, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MICHEL AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-4523
Mailing Address - Country:US
Mailing Address - Phone:631-782-6523
Mailing Address - Fax:631-842-7977
Practice Address - Street 1:201 DIXON AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2832
Practice Address - Country:US
Practice Address - Phone:631-782-6526
Practice Address - Fax:631-842-7977
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0773361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07200067950Medicaid