Provider Demographics
NPI:1982823993
Name:MARSHA THAW, LCSW, INC.
Entity Type:Organization
Organization Name:MARSHA THAW, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARSHA
Authorized Official - Middle Name:T
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW BCD
Authorized Official - Phone:949-951-9655
Mailing Address - Street 1:25301 CABOT RD
Mailing Address - Street 2:SUITE 116
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5523
Mailing Address - Country:US
Mailing Address - Phone:949-951-9655
Mailing Address - Fax:949-951-9654
Practice Address - Street 1:25301 CABOT RD
Practice Address - Street 2:SUITE 116
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5523
Practice Address - Country:US
Practice Address - Phone:949-951-9655
Practice Address - Fax:949-951-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW 5254Medicare ID - Type Unspecified