Provider Demographics
NPI:1245509884
Name:NELSON, MARIAN AMLIE
Entity type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:AMLIE
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIAN
Other - Middle Name:AMLIE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3867 HOWE ST
Mailing Address - Street 2:1
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5343
Mailing Address - Country:US
Mailing Address - Phone:510-654-6411
Mailing Address - Fax:510-654-6411
Practice Address - Street 1:3867 HOWE ST
Practice Address - Street 2:1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5343
Practice Address - Country:US
Practice Address - Phone:510-654-6411
Practice Address - Fax:510-654-6411
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 7582104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker