Provider Demographics
NPI:1760661912
Name:VANDER SLUIS, MARYELLEN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYELLEN
Middle Name:
Last Name:VANDER SLUIS
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 1:1515 MEEK AVE
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-1519
Mailing Address - Country:US
Mailing Address - Phone:707-255-5231
Mailing Address - Fax:
Practice Address - Street 1:1515 MEEK AVE
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-1519
Practice Address - Country:US
Practice Address - Phone:707-255-5231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS85141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical