Healthcare Provider Details

I. General information

NPI: 1558438747
Provider Name (Legal Business Name): MICHAEL A. MARSMAN L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 09/11/2023
Certification Date: 09/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 DOMINGO AVE STE 203
BERKELEY CA
94705-2400
US

IV. Provider business mailing address

2920 DOMINGO AVE STE 203
BERKELEY CA
94705-2400
US

V. Phone/Fax

Practice location:
  • Phone: 510-529-5955
  • Fax:
Mailing address:
  • Phone: 510-529-5955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR069295
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW92899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: