Provider Demographics
NPI:1396808713
Name:BERRETTA, MARCIA (LCSW)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:
Last Name:BERRETTA
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 1:2 E GREENWAY PLZ
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0297
Mailing Address - Country:US
Mailing Address - Phone:713-798-1750
Mailing Address - Fax:713-798-1144
Practice Address - Street 1:6621 FANNIN ST
Practice Address - Street 2:SUITE A340
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2303
Practice Address - Country:US
Practice Address - Phone:832-826-1380
Practice Address - Fax:832-825-2799
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX240781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040330501Medicaid
TX82371WMedicare ID - Type Unspecified
TX8L5276Medicare PIN
TX040330501Medicaid