Provider Demographics
NPI:1831477462
Name:COCKRELL, MARILYN BETH (LCSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:BETH
Last Name:COCKRELL
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 1:2601 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-3309
Mailing Address - Country:US
Mailing Address - Phone:302-655-9624
Mailing Address - Fax:302-655-9753
Practice Address - Street 1:2601 W 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805-3309
Practice Address - Country:US
Practice Address - Phone:302-655-9624
Practice Address - Fax:302-655-9753
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00001421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical