Provider Demographics
NPI:1699897918
Name:COLBECK, MARLENE LOUISE (MSWLCSW)
Entity type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:LOUISE
Last Name:COLBECK
Suffix:
Gender:F
Credentials:MSWLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MERCHANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-1925
Mailing Address - Country:US
Mailing Address - Phone:856-910-7553
Mailing Address - Fax:
Practice Address - Street 1:584 BENSON ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1324
Practice Address - Country:US
Practice Address - Phone:856-964-1990
Practice Address - Fax:856-964-1993
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04676000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7386548OtherAETNA
NJ8591008Medicaid
NJ2321174000OtherAMERIHEALTH
NJ8591008Medicaid