Provider Demographics
NPI:1376204982
Name:MARSALA, MITCHELL DANIEL
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:DANIEL
Last Name:MARSALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 KINGS ROW
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2008
Mailing Address - Country:US
Mailing Address - Phone:775-443-0012
Mailing Address - Fax:
Practice Address - Street 1:180 COUNTRY ESTATES CIR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-4013
Practice Address - Country:US
Practice Address - Phone:775-870-5027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical