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General NPI Number Information
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NPI Number | 1689959223
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Entity Type | Individual
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Provider Name | MS. MARLENE A DENNIS
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Gender | Female
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 135 W 50TH ST # W
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City | NEW YORK
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State | NY
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Zip | 10020-1201
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Country | US
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Telephone | 212-304-1430
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Fax | 718-365-2777
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Provider Business Mailing Address
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Address Line | 10325 168TH PL
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City | JAMAICA
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State | NY
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Zip | 11433-1727
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Country | US
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Telephone | 917-288-8736
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Fax |
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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 | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 320800000X
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License Number State | NY
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