Provider Demographics
NPI:1962948950
Name:ESOLEN, MARIANNE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:
Last Name:ESOLEN
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 1:27 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1351
Mailing Address - Country:US
Mailing Address - Phone:631-424-4979
Mailing Address - Fax:
Practice Address - Street 1:23 GREEN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3336
Practice Address - Country:US
Practice Address - Phone:631-219-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-13
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079854-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical