Provider Demographics
NPI:1063091080
Name:MUNIZ-MARRERO, JACKELINE E
Entity type:Individual
Prefix:
First Name:JACKELINE
Middle Name:E
Last Name:MUNIZ-MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 21ST ST APT F9
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3060
Mailing Address - Country:US
Mailing Address - Phone:718-594-4254
Mailing Address - Fax:
Practice Address - Street 1:111 E 21ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-3062
Practice Address - Country:US
Practice Address - Phone:718-594-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical