Provider Demographics
NPI:1588760078
Name:COLE, MARILYN JOY (LISW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:JOY
Last Name:COLE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2374
Mailing Address - Country:US
Mailing Address - Phone:614-559-0130
Mailing Address - Fax:614-231-4978
Practice Address - Street 1:1070 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2374
Practice Address - Country:US
Practice Address - Phone:614-559-0130
Practice Address - Fax:614-231-4978
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00036711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCOSW24401Medicare ID - Type Unspecified