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General NPI Number Information
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NPI Number | 1881753630
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Entity Type | Individual
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Provider Name | MARILYN M. MOTA LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 110 W 97TH ST
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City | NEW YORK
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State | NY
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Zip | 10025-6450
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Country | US
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Telephone | 212-749-1820
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Fax | 212-866-0949
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Provider Business Mailing Address
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Address Line | 357 E 201ST ST APT 2K
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City | BRONX
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State | NY
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Zip | 10458-2205
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Country | US
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Telephone | 718-220-6104
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 075129-1
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License Number State | NY
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