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NPI Code Detail

MEDICARE: MARILYN T PAVENTY LCSW

MEDICARE: MARILYN T PAVENTY LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorASW71248CA
2104100000XSocial WorkerASW26233CA
3171M00000XCase Manager/Care CoordinatorASW 71248CA
4101YM0800XMental Health Counselor98396CA

General Provider Information

NPI Number : 1659503175
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN T PAVENTY LCSW
Provider Business Mailing Address
First Line : 22425 SUNBRIGHT AVE
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-9741
Country : US
Telephone Number : 530-528-2342
Fax Number :
Provider Business Practice Location Address
First Line : 22425 SUNBRIGHT AVE
Second Line :
City : RED BLUFF
State : CA
Zip : 96080-9741
Country : US
Telephone Number : 530-528-2342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2009
Last Update Date : 02/28/2023

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