Provider Demographics
NPI:1417161399
Name:WOERTZ, MARLENE (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:WOERTZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 CLINTON WAY
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-7630
Mailing Address - Country:US
Mailing Address - Phone:530-676-2264
Mailing Address - Fax:530-676-2274
Practice Address - Street 1:4120 CAMERON PARK DR
Practice Address - Street 2:SUITE 403
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-7212
Practice Address - Country:US
Practice Address - Phone:530-676-4370
Practice Address - Fax:530-676-2274
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC21990OtherLMFT