Healthcare Provider Details

I. General information

NPI: 1760839153
Provider Name (Legal Business Name): ANDREA DENISE MAREZ LCSW 109067
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 N LINCOLN ST
SANTA MARIA CA
93458-4319
US

IV. Provider business mailing address

1017 N CONCEPCION AVE
SANTA MARIA CA
93454-2321
US

V. Phone/Fax

Practice location:
  • Phone: 805-598-4115
  • Fax:
Mailing address:
  • Phone: 805-598-4115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number109067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number109067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: