Provider Demographics
NPI:1760839153
Name:MAREZ, ANDREA DENISE (LCSW 109067)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:MAREZ
Suffix:
Gender:F
Credentials:LCSW 109067
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 N CONCEPCION AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-2321
Mailing Address - Country:US
Mailing Address - Phone:805-598-4115
Mailing Address - Fax:
Practice Address - Street 1:105 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4319
Practice Address - Country:US
Practice Address - Phone:805-598-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-16
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW88060101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health