Provider Demographics
NPI:1871086215
Name:TAITT, MARLENE LEOLINE
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:LEOLINE
Last Name:TAITT
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 1:1293 DEAN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3462
Mailing Address - Country:US
Mailing Address - Phone:347-296-7140
Mailing Address - Fax:718-604-2047
Practice Address - Street 1:1293 DEAN ST APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3462
Practice Address - Country:US
Practice Address - Phone:347-296-7140
Practice Address - Fax:718-604-2047
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst