Provider Demographics
NPI:1831869510
Name:MARRIOTT, SANAYAH VERTULIE (LCSW)
Entity type:Individual
Prefix:
First Name:SANAYAH
Middle Name:VERTULIE
Last Name:MARRIOTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 CAMINO CANTERA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3336
Mailing Address - Country:US
Mailing Address - Phone:619-650-4881
Mailing Address - Fax:
Practice Address - Street 1:858 CAMINO CANTERA
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3336
Practice Address - Country:US
Practice Address - Phone:619-650-4881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI51631041C0700X
CA1238101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1790381184Medicaid