Provider Demographics
NPI:1598514440
Name:KOLOVITZ, MARLA GOLDEN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:MARLA
Middle Name:GOLDEN
Last Name:KOLOVITZ
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 1:2938 DESPLAINES AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1852
Mailing Address - Country:US
Mailing Address - Phone:708-268-0725
Mailing Address - Fax:
Practice Address - Street 1:2938 DESPLAINES AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1852
Practice Address - Country:US
Practice Address - Phone:708-268-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0264621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical