Healthcare Provider Details

I. General information

NPI: 1093963241
Provider Name (Legal Business Name): MARCILENO K REED LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2008
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139C E JACKSON AVE
MONTICELLO AR
71655-4933
US

IV. Provider business mailing address

139C E JACKSON AVE
MONTICELLO AR
71655-4933
US

V. Phone/Fax

Practice location:
  • Phone: 870-224-8108
  • Fax: 870-224-8110
Mailing address:
  • Phone: 870-224-8108
  • Fax: 870-224-8110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number1075-M
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: