Provider Demographics
NPI:1881753630
Name:MOTA, MARILYN M (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:M
Last Name:MOTA
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 1:357 E 201ST ST
Mailing Address - Street 2:APT 2K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-2205
Mailing Address - Country:US
Mailing Address - Phone:718-220-6104
Mailing Address - Fax:
Practice Address - Street 1:110 W 97TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6450
Practice Address - Country:US
Practice Address - Phone:212-749-1820
Practice Address - Fax:212-866-0949
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075129-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical