Provider Demographics
NPI:1861299463
Name:MARIE, SYLVIA (LCSW, MFT)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:MARIE
Suffix:
Gender:F
Credentials:LCSW, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6107 BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-9106
Mailing Address - Country:US
Mailing Address - Phone:707-829-1772
Mailing Address - Fax:
Practice Address - Street 1:6107 BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-9106
Practice Address - Country:US
Practice Address - Phone:707-829-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5154106H00000X
CA35311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist