Provider Demographics
NPI:1699184838
Name:ENGLEMAN, MARISSA (LCSW, LICSW)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:ENGLEMAN
Suffix:
Gender:F
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10775 PIONEER TRL STE 215
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-0234
Mailing Address - Country:US
Mailing Address - Phone:775-291-8713
Mailing Address - Fax:
Practice Address - Street 1:2730 SALVIO ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519
Practice Address - Country:US
Practice Address - Phone:925-682-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-12
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X, 1041S0200X
CA1018661041C0700X
WA612908101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool