Provider Demographics
NPI:1255594917
Name:KATZ, MARYASHA (MARCIE) LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARYASHA (MARCIE)
Middle Name:LYNN
Last Name:KATZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARYASHA
Other - Middle Name:
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1215
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-1215
Mailing Address - Country:US
Mailing Address - Phone:831-234-5813
Mailing Address - Fax:
Practice Address - Street 1:320 RIVER ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2723
Practice Address - Country:US
Practice Address - Phone:831-234-5813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS214031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical