Provider Demographics
NPI:1447962501
Name:DOVE, MARLEY KAYA
Entity type:Individual
Prefix:
First Name:MARLEY
Middle Name:KAYA
Last Name:DOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442 BEDFORD AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3824
Mailing Address - Country:US
Mailing Address - Phone:336-290-2569
Mailing Address - Fax:
Practice Address - Street 1:68 JAY ST STE 620
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-8362
Practice Address - Country:US
Practice Address - Phone:336-290-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health