Provider Demographics
NPI:1205469426
Name:REESE, MARISA WILSON (LCSW)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:WILSON
Last Name:REESE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:SHEA
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4205 CORTE CT
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-6480
Mailing Address - Country:US
Mailing Address - Phone:760-500-0742
Mailing Address - Fax:
Practice Address - Street 1:2525 PIO PICO DR
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1568
Practice Address - Country:US
Practice Address - Phone:760-431-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW800261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical