Provider Demographics
NPI:1417029497
Name:MALATESTA, MARSALEE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARSALEE
Middle Name:
Last Name:MALATESTA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5144 E CORALITE ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3408
Mailing Address - Country:US
Mailing Address - Phone:562-431-8822
Mailing Address - Fax:562-431-8875
Practice Address - Street 1:3662 KATELLA AVE STE 116
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3126
Practice Address - Country:US
Practice Address - Phone:562-431-8822
Practice Address - Fax:562-431-8875
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS217621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical