Provider Demographics
NPI:1740485499
Name:WIENER, MARIAN DENZER (MSW LCSW)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:DENZER
Last Name:WIENER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 OAKLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:KENDALL PK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-297-5230
Mailing Address - Fax:
Practice Address - Street 1:570 LEE ST
Practice Address - Street 2:RARITAN BAY MENTAL HEALTH CENTER
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861
Practice Address - Country:US
Practice Address - Phone:732-442-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04577800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
644057CYQMedicare PIN