=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245096379
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISSA GUNAL ASW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 02/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34275 PACIFIC COAST HIGHWAY
-----------------------------------------------------
City | DANA POINT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92629-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-867-9942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34275 PACIFIC COAST HIGHWAY
-----------------------------------------------------
City | DANA POINT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92629-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-867-9942
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | ASW120623
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------