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General NPI Number Information
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NPI Number | 1386135192
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Entity Type | Organization
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Legal Business Name | MARISSA BORTENSTEIN, LCSW, PLLC
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 7701 N LAMAR BLVD STE 328
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City | AUSTIN
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State | TX
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Zip | 78752-1080
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Country | US
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Telephone | 512-265-5220
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 49431
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City | AUSTIN
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State | TX
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Zip | 78765-9431
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Country | US
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Telephone | 512-265-5220
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARISSA BORTENSTEIN
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Credential | LCSW
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Telephone | 512-265-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 59315
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License Number State | TX
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