Provider Demographics
NPI:1669619409
Name:DEFOORE, MARNEY WAYNE (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARNEY
Middle Name:WAYNE
Last Name:DEFOORE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4203 WOODCOCK DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1312
Mailing Address - Country:US
Mailing Address - Phone:210-883-7877
Mailing Address - Fax:888-366-6472
Practice Address - Street 1:4203 WOODCOCK DRIVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1312
Practice Address - Country:US
Practice Address - Phone:210-883-7877
Practice Address - Fax:888-366-6472
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical