Provider Demographics
NPI:1649965500
Name:BOENI, MARLENA ANN (PMHNP)
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:ANN
Last Name:BOENI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 PINEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-2813
Mailing Address - Country:US
Mailing Address - Phone:848-333-4658
Mailing Address - Fax:
Practice Address - Street 1:39 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-2813
Practice Address - Country:US
Practice Address - Phone:848-333-4658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2022095798363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health