Provider Demographics
NPI:1588061899
Name:GENTNER, MARILYN MARIE (LICSW, LMSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:MARIE
Last Name:GENTNER
Suffix:
Gender:F
Credentials:LICSW, LMSW
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:MARIE
Other - Last Name:BEARDSLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1012 14TH ST NW STE 810
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-3403
Mailing Address - Country:US
Mailing Address - Phone:202-654-5155
Mailing Address - Fax:202-654-0898
Practice Address - Street 1:1012 14TH ST NW STE 810
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-3403
Practice Address - Country:US
Practice Address - Phone:202-654-5155
Practice Address - Fax:202-654-0898
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC50081801041C0700X
MI68010957271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical