Basic Information
| Provider Information | |||||||||
| NPI: | 1063990349 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARRONE | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MSW, ACSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARRONE | ||||||||
| OtherFirstName: | MARY BETH | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15230 EARLHAM ST | ||||||||
| Address2: | |||||||||
| City: | PACIFIC PALISADES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902724341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105703421 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1055 E COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911062327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614021545 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2018 | ||||||||
| LastUpdateDate: | 07/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | CA | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | ASW81483 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.