Healthcare Provider Details

I. General information

NPI: 1710530670
Provider Name (Legal Business Name): MARISSA DANEA LONG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 03/10/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935B SPRING ST
PLACERVILLE CA
95667-4523
US

IV. Provider business mailing address

122 S LINCOLN ST
ROSEVILLE CA
95678-2741
US

V. Phone/Fax

Practice location:
  • Phone: 530-748-4709
  • Fax: 530-748-4750
Mailing address:
  • Phone: 530-515-7035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: