Provider Demographics
NPI:1528875317
Name:AQUINO, MARJORIE ALYSSA (LSW)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ALYSSA
Last Name:AQUINO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BELLEVIEW AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1447
Mailing Address - Country:US
Mailing Address - Phone:973-997-6568
Mailing Address - Fax:
Practice Address - Street 1:306 LATHROP AVE
Practice Address - Street 2:
Practice Address - City:BOONTON
Practice Address - State:NJ
Practice Address - Zip Code:07005-2253
Practice Address - Country:US
Practice Address - Phone:973-335-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL072201001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical