Provider Demographics
NPI:1043596968
Name:PANTANO, MARILYN JEAN (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JEAN
Last Name:PANTANO
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 1:48 GRAY BIRCH CT
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2144
Mailing Address - Country:US
Mailing Address - Phone:716-407-9175
Mailing Address - Fax:716-407-9182
Practice Address - Street 1:9265 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1912
Practice Address - Country:US
Practice Address - Phone:716-407-9175
Practice Address - Fax:716-407-9182
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042393-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY042393-1OtherLICENSED MASTER SOCIAL WORKER