Healthcare Provider Details

I. General information

NPI: 1164750436
Provider Name (Legal Business Name): MARILYNN MCSEVENEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYNN MCSEVENEY MSW

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 02/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 APPLE AVE
GRASS VALLEY CA
95945-4016
US

IV. Provider business mailing address

PO BOX 1098
NEVADA CITY CA
95959-1098
US

V. Phone/Fax

Practice location:
  • Phone: 530-271-7404
  • Fax: 530-271-7404
Mailing address:
  • Phone: 530-263-5361
  • Fax: 530-263-5361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3877
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3877
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: