Provider Demographics
NPI:1073292660
Name:HERNANDEZ, MARISSA LESETTE (MSW)
Entity Type:Individual
Prefix:MISS
First Name:MARISSA
Middle Name:LESETTE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12142 CENTRAL AVE # 177
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2420
Mailing Address - Country:US
Mailing Address - Phone:619-446-9093
Mailing Address - Fax:
Practice Address - Street 1:746 TAFT AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6445
Practice Address - Country:US
Practice Address - Phone:619-446-9093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA909211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical