Provider Demographics
NPI:1548381882
Name:CREVELLO, MARILYNNE LEE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARILYNNE
Middle Name:LEE
Last Name:CREVELLO
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 1:4890 OLD CLIFFS RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-1142
Mailing Address - Country:US
Mailing Address - Phone:619-501-5205
Mailing Address - Fax:
Practice Address - Street 1:4890 OLD CLIFFS RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-1142
Practice Address - Country:US
Practice Address - Phone:619-501-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 197351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical