Provider Demographics
NPI:1922711308
Name:MARMOLEJOS, JOCELYNN MIA (RCSWI, LMSW, MSW)
Entity type:Individual
Prefix:
First Name:JOCELYNN
Middle Name:MIA
Last Name:MARMOLEJOS
Suffix:
Gender:F
Credentials:RCSWI, LMSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NW 183RD ST STE 404
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4619
Mailing Address - Country:US
Mailing Address - Phone:212-920-0229
Mailing Address - Fax:
Practice Address - Street 1:111 NW 183RD ST STE 404
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4619
Practice Address - Country:US
Practice Address - Phone:212-920-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116451104100000X
ISW193721041C0700X
FLISW19372104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical