Provider Demographics
NPI:1699332544
Name:POWELL, MARILYN (LMHC)
Entity type:Individual
Prefix:MISS
First Name:MARILYN
Middle Name:
Last Name:POWELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 WALLACE AVE APT 246
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2504
Mailing Address - Country:US
Mailing Address - Phone:917-572-7393
Mailing Address - Fax:
Practice Address - Street 1:255 W 36TH ST FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7585
Practice Address - Country:US
Practice Address - Phone:212-378-4545
Practice Address - Fax:646-723-1567
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health