Provider Demographics
NPI:1063990349
Name:MARRONE, MARY ELIZABETH (MSW, ACSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:MARRONE
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:
Other - First Name:MARY BETH
Other - Middle Name:
Other - Last Name:MARRONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15230 EARLHAM ST
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4341
Mailing Address - Country:US
Mailing Address - Phone:310-570-3421
Mailing Address - Fax:
Practice Address - Street 1:1055 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2327
Practice Address - Country:US
Practice Address - Phone:661-402-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
CAASW81483104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker