Provider Demographics
NPI:1841460458
Name:MARRIOTT, KARA THERESA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:THERESA
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:KARA
Other - Middle Name:THERESA
Other - Last Name:PITTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1620 CHARLTON STREET #212
Mailing Address - Street 2:
Mailing Address - City:WEST ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118
Mailing Address - Country:US
Mailing Address - Phone:651-402-3537
Mailing Address - Fax:
Practice Address - Street 1:1620 CHARLTON STREET #212
Practice Address - Street 2:
Practice Address - City:WEST ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118
Practice Address - Country:US
Practice Address - Phone:651-402-3537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-11
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN150271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical