Provider Demographics
NPI:1588873442
Name:MAYNE, MICHELLE MARGUERITE (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:MARGUERITE
Last Name:MAYNE
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3636 MAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2131
Mailing Address - Country:US
Mailing Address - Phone:775-250-2741
Mailing Address - Fax:775-329-3222
Practice Address - Street 1:557 CALIFORNIA AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-1449
Practice Address - Country:US
Practice Address - Phone:775-329-3222
Practice Address - Fax:775-329-3222
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4562-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical