Provider Demographics
NPI:1467661769
Name:VAYDER, MARCY R (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:R
Last Name:VAYDER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:MARCY
Other - Middle Name:RENE
Other - Last Name:HIXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SWA
Mailing Address - Street 1:PO BOX 622
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95617-0622
Mailing Address - Country:US
Mailing Address - Phone:530-756-7542
Mailing Address - Fax:916-875-9970
Practice Address - Street 1:1784 PICASSO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-0551
Practice Address - Country:US
Practice Address - Phone:530-756-7542
Practice Address - Fax:530-756-2931
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical