MEDICARE: MISS MARILYN POWELL LMHC

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
1	101YM0800X	Mental Health Counselor	009463	NY

General Provider Information

NPI Number	:	1699332544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARILYN POWELL LMHC

Provider Business Mailing Address
First Line	:	2132 WALLACE AVE APT 246
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10462-2504
Country	:	US
Telephone Number	:	917-572-7393
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 W 36TH ST FL 8
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-7585
Country	:	US
Telephone Number	:	212-378-4545
Fax Number	:	646-723-1567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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