Provider Demographics
NPI:1164750436
Name:MCSEVENEY, MARILYNN
Entity Type:Individual
Prefix:
First Name:MARILYNN
Middle Name:
Last Name:MCSEVENEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARILYNN
Other - Middle Name:
Other - Last Name:MCSEVENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 1098
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1098
Mailing Address - Country:US
Mailing Address - Phone:530-263-5361
Mailing Address - Fax:530-263-5361
Practice Address - Street 1:173 APPLE AVE
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-4016
Practice Address - Country:US
Practice Address - Phone:530-271-7404
Practice Address - Fax:530-271-7404
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA38771041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical