Provider Demographics
NPI:1699825091
Name:CREMIN, MARIAN H (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:H
Last Name:CREMIN
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-0126
Mailing Address - Country:US
Mailing Address - Phone:415-488-1539
Mailing Address - Fax:
Practice Address - Street 1:895 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1916
Practice Address - Country:US
Practice Address - Phone:415-459-5206
Practice Address - Fax:415-459-5262
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA204711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ21603ZMedicare ID - Type Unspecified
S31241Medicare UPIN