Provider Demographics
NPI:1114113586
Name:NEVILLE, MARCIA VASCONCELOS (LMFT)
Entity Type:Individual
Prefix:MISS
First Name:MARCIA
Middle Name:VASCONCELOS
Last Name:NEVILLE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:685 JASPER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-2392
Mailing Address - Country:US
Mailing Address - Phone:805-889-0872
Mailing Address - Fax:
Practice Address - Street 1:10601 VINCA LANE #202
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93004-1819
Practice Address - Country:US
Practice Address - Phone:805-889-0872
Practice Address - Fax:805-384-1555
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40995101YA0400X
CAMFC 40995106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01592204OtherMEDICAL PIN