Provider Demographics
NPI:1538505292
Name:CHATTERTON, MARINA TALLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:TALLEY
Last Name:CHATTERTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:HUGHES
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3608 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1736
Mailing Address - Country:US
Mailing Address - Phone:415-292-7956
Mailing Address - Fax:
Practice Address - Street 1:3608 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1736
Practice Address - Country:US
Practice Address - Phone:415-292-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical