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General NPI Number Information
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NPI Number | 1124249636
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Entity Type | Individual
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Provider Name | MARLIENNE CARRIE CHRISTIAN LCSW, ACSW
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Gender | Female
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 06/07/2011
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Provider Practice Location Address
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Address Line | 722 MYRTLE AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-3905
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Country | US
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Telephone | 718-636-4213
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Fax | 718-875-3046
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Provider Business Mailing Address
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Address Line | 5 AGATE CT
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City | BROOKLYN
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State | NY
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Zip | 11213-1002
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Country | US
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Telephone | 718-774-0249
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Fax | 718-774-0249
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076570-1
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License Number State | NY
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