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NPI Code Detail

MEDICARE: MARILYN L. HENRY MS, MSSA, LISW, ACSW

MEDICARE: MARILYN L. HENRY MS, MSSA, LISW, ACSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerI-0004780OH

General Provider Information

NPI Number : 1295819001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN L. HENRY MS, MSSA, LISW, ACSW
Provider Business Mailing Address
First Line : 1433 5TH ST NW
Second Line :
City : NEW PHILADELPHIA
State : OH
Zip : 44663-1223
Country : US
Telephone Number : 330-343-8171
Fax Number : 330-343-8439
Provider Business Practice Location Address
First Line : 1433 5TH ST NW
Second Line :
City : NEW PHILADELPHIA
State : OH
Zip : 44663-1223
Country : US
Telephone Number : 330-343-8171
Fax Number : 330-343-8439
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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