Provider Demographics
NPI:1700134467
Name:MARRIOTT, CAROLINE ANTONIA (LCSW)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANTONIA
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:981 E 3665 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4722
Mailing Address - Country:US
Mailing Address - Phone:202-421-3113
Mailing Address - Fax:
Practice Address - Street 1:981 E 3665 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-4722
Practice Address - Country:US
Practice Address - Phone:202-421-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8620762-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical