Provider Demographics
NPI:1215437504
Name:BORTENSTEIN, MARISSA (LCSW)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:BORTENSTEIN
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:PO BOX 49431
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78765-9431
Mailing Address - Country:US
Mailing Address - Phone:512-265-5220
Mailing Address - Fax:
Practice Address - Street 1:7701 N LAMAR BLVD STE 313
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1080
Practice Address - Country:US
Practice Address - Phone:512-265-5220
Practice Address - Fax:512-532-6896
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX593151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical