Provider Demographics
NPI:1992845119
Name:ZWETOW, MARISSA TOWNLEY
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:TOWNLEY
Last Name:ZWETOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VANCOUVER
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-6079
Mailing Address - Country:US
Mailing Address - Phone:714-342-3734
Mailing Address - Fax:
Practice Address - Street 1:4 VANCOUVER
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-6079
Practice Address - Country:US
Practice Address - Phone:714-342-3734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist