Provider Demographics
NPI:1063926814
Name:MILLS-MARGESSON, MARLENE KAE (LCSW)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:KAE
Last Name:MILLS-MARGESSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3512 CALLE VERANO
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2722
Mailing Address - Country:US
Mailing Address - Phone:949-547-3853
Mailing Address - Fax:
Practice Address - Street 1:3512 CALLE VERANO
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2722
Practice Address - Country:US
Practice Address - Phone:949-547-3853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA211731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical