Provider Demographics
NPI:1568176907
Name:MARQUEZ, LISETT M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LISETT
Middle Name:M
Last Name:MARQUEZ
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 1:815 W VIA RANCHO SAHUARITA UNIT 205
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-1108
Mailing Address - Country:US
Mailing Address - Phone:520-261-1345
Mailing Address - Fax:
Practice Address - Street 1:815 W VIA RANCHO SAHUARITA UNIT 205
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-1108
Practice Address - Country:US
Practice Address - Phone:520-261-1345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-10
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-216751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-21675OtherLICENSED CLINICAL SOCIAL WORKER