Provider Demographics
NPI:1740833631
Name:PIERRE, W MARILYNN (LMSW)
Entity type:Individual
Prefix:
First Name:W MARILYNN
Middle Name:
Last Name:PIERRE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 E 149TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5626
Mailing Address - Country:US
Mailing Address - Phone:718-769-2698
Mailing Address - Fax:718-292-0208
Practice Address - Street 1:329 E 149TH ST FL 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5626
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:718-292-0208
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY066666104100000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty