Provider Demographics
NPI:1124249636
Name:CHRISTIAN, MARLIENNE CARRIE (LCSW, ACSW)
Entity type:Individual
Prefix:MS
First Name:MARLIENNE
Middle Name:CARRIE
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 AGATE CT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1002
Mailing Address - Country:US
Mailing Address - Phone:718-774-0249
Mailing Address - Fax:718-774-0249
Practice Address - Street 1:722 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3905
Practice Address - Country:US
Practice Address - Phone:718-636-4213
Practice Address - Fax:718-875-3046
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076570-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical