Healthcare Provider Details

I. General information

NPI: 1972320810
Provider Name (Legal Business Name): MARIANNE HUNT LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/29/2026
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 AVENIDA SEVILLA UNIT A
LAGUNA WOODS CA
92637-7125
US

IV. Provider business mailing address

23710 EL TORO RD # 1018
LAKE FOREST CA
92630-4711
US

V. Phone/Fax

Practice location:
  • Phone: 213-265-0428
  • Fax:
Mailing address:
  • Phone: 213-265-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: MARIANNE HUNT
Title or Position: CEO
Credential: LCSW
Phone: 323-605-3592