Provider Demographics
NPI:1518370287
Name:MARRERO, LAWANDA JERUS MARIE
Entity Type:Individual
Prefix:
First Name:LAWANDA
Middle Name:JERUS MARIE
Last Name:MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 VERMONT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4534
Mailing Address - Country:US
Mailing Address - Phone:510-593-5367
Mailing Address - Fax:
Practice Address - Street 1:1718 VERMONT ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4534
Practice Address - Country:US
Practice Address - Phone:510-593-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT139411101Y00000X, 101YM0800X
101Y00000X
CA90692106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health