Provider Demographics
NPI:1083299986
Name:GUDIEL, MARLEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARLEN
Middle Name:
Last Name:GUDIEL
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:PO BOX 14942
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90853-4900
Mailing Address - Country:US
Mailing Address - Phone:562-726-4046
Mailing Address - Fax:
Practice Address - Street 1:800 CARILLON PKWY STE 220
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1113
Practice Address - Country:US
Practice Address - Phone:562-334-2444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-11
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1247831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical