Provider Demographics
NPI:1962049296
Name:BLACKWELL, MARSINLEN HOPE
Entity type:Individual
Prefix:
First Name:MARSINLEN
Middle Name:HOPE
Last Name:BLACKWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARSINLEN
Other - Middle Name:
Other - Last Name:BLACKWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:201 LACKAWANNA AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1953
Mailing Address - Country:US
Mailing Address - Phone:570-877-5045
Mailing Address - Fax:272-235-3568
Practice Address - Street 1:201 LACKAWANNA AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1953
Practice Address - Country:US
Practice Address - Phone:570-877-5045
Practice Address - Fax:272-235-3568
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)