Basic Information
| Provider Information | |||||||||
| NPI: | 1669674776 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEPULVEDA | ||||||||
| FirstName: | MARLYN | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3737 MARCONI AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958215303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164801801 | ||||||||
| FaxNumber: | 9164801809 | ||||||||
| Practice Location | |||||||||
| Address1: | 3737 MARCONI AVE | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958215303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164801801 | ||||||||
| FaxNumber: | 9164801809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 61921 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | 61921 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.