Provider Demographics
NPI:1659503175
Name:PAVENTY, MARILYN T (LCSW)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:T
Last Name:PAVENTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:T
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22425 SUNBRIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-9741
Mailing Address - Country:US
Mailing Address - Phone:530-528-2342
Mailing Address - Fax:
Practice Address - Street 1:22425 SUNBRIGHT AVE
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-9741
Practice Address - Country:US
Practice Address - Phone:530-528-2342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW71248101YM0800X
CAASW26233104100000X
CAASW 71248171M00000X
CA98396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator