Provider Demographics
NPI:1205258688
Name:PERSCHNICK, MARNI
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:
Last Name:PERSCHNICK
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:PO BOX 5743
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-5743
Mailing Address - Country:US
Mailing Address - Phone:530-205-3142
Mailing Address - Fax:
Practice Address - Street 1:160 PINE RIDGE DR
Practice Address - Street 2:
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-9805
Practice Address - Country:US
Practice Address - Phone:530-205-3142
Practice Address - Fax:530-725-4505
Is Sole Proprietor?:No
Enumeration Date:2014-01-20
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 363841041C0700X
NV8427-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical