Provider Demographics
NPI:1245298058
Name:MUNNELLY, MARYANNE (LCSW)
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:MUNNELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 ARROWHEAD LN
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3314
Mailing Address - Country:US
Mailing Address - Phone:631-476-7141
Mailing Address - Fax:631-476-7665
Practice Address - Street 1:53 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3314
Practice Address - Country:US
Practice Address - Phone:631-476-7141
Practice Address - Fax:631-476-7665
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY06945711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical