Provider Demographics
NPI:1992100259
Name:MARROQUIN, ABRIAL KATHRYN-ANNE (CSW)
Entity type:Individual
Prefix:
First Name:ABRIAL
Middle Name:KATHRYN-ANNE
Last Name:MARROQUIN
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S 200 W APT 4
Mailing Address - Street 2:
Mailing Address - City:BRIGHAM CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-2504
Mailing Address - Country:US
Mailing Address - Phone:435-213-6141
Mailing Address - Fax:
Practice Address - Street 1:130 S 200 W APT 4
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-2504
Practice Address - Country:US
Practice Address - Phone:435-213-6141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8116113-35021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical