Provider Demographics
NPI:1902187594
Name:MARSELINE, AMY LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:LYNN
Last Name:MARSELINE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E SAN FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3503
Mailing Address - Country:US
Mailing Address - Phone:408-899-7149
Mailing Address - Fax:408-514-2384
Practice Address - Street 1:195 E SAN FERNANDO ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3503
Practice Address - Country:US
Practice Address - Phone:408-899-7149
Practice Address - Fax:408-514-2384
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker