Provider Demographics
NPI:1104256908
Name:MARTINELLI, MARCI (MS)
Entity type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:MARTINELLI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SKI RUN BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-9010
Mailing Address - Country:US
Mailing Address - Phone:530-721-3525
Mailing Address - Fax:
Practice Address - Street 1:1235 SKI RUN BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-9010
Practice Address - Country:US
Practice Address - Phone:530-721-3525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUIMF-107101YM0800X
CALMFT84745106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health