Provider Demographics
NPI:1619141371
Name:BRENT, MARLENE TERRY (LIC CLINICAL SOCIAL)
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:TERRY
Last Name:BRENT
Suffix:
Gender:F
Credentials:LIC CLINICAL SOCIAL
Other - Prefix:
Other - First Name:MARLENE
Other - Middle Name:TERRY
Other - Last Name:SUFFET/DUNBRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2608 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-7105
Mailing Address - Country:US
Mailing Address - Phone:916-765-8923
Mailing Address - Fax:
Practice Address - Street 1:7551 TIMBERLAKE WAY
Practice Address - Street 2:SUITE 240
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5420
Practice Address - Country:US
Practice Address - Phone:916-765-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical