Provider Demographics
NPI:1174930879
Name:MARINELLI,LMSW, ANTOINETTE (LMSW)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:MARINELLI,LMSW
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 DEWITT ST STE 205A
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2892
Mailing Address - Country:US
Mailing Address - Phone:315-450-2925
Mailing Address - Fax:315-457-4244
Practice Address - Street 1:112 DEWITT ST STE 205A
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2892
Practice Address - Country:US
Practice Address - Phone:315-450-2925
Practice Address - Fax:315-457-4244
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091572-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health