Provider Demographics
NPI:1548299100
Name:JURON, MARLENE MILLER (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:MILLER
Last Name:JURON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:MILLER
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5317 FRUITVILLE RD # 4
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6402
Mailing Address - Country:US
Mailing Address - Phone:941-302-5008
Mailing Address - Fax:
Practice Address - Street 1:5317 FRUITVILLE RD # 4
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6402
Practice Address - Country:US
Practice Address - Phone:941-302-5008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA090404440441041C0700X
FLSW185171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0904004044Medicare UPIN