Provider Demographics
NPI:1972229789
Name:SEPULVEDA, MARISSA AARON (CSWI)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:AARON
Last Name:SEPULVEDA
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:931 GLEN MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-2519
Mailing Address - Country:US
Mailing Address - Phone:775-901-6560
Mailing Address - Fax:775-448-9761
Practice Address - Street 1:6490 S MCCARRAN BLVD STE A6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6119
Practice Address - Country:US
Practice Address - Phone:775-448-9760
Practice Address - Fax:775-448-9761
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty