Provider Demographics
NPI:1053764514
Name:MARNEWECKE, VANESSA (MA)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:MARNEWECKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4381
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95518-4381
Mailing Address - Country:US
Mailing Address - Phone:707-498-7623
Mailing Address - Fax:
Practice Address - Street 1:1085 I ST STE 203
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5588
Practice Address - Country:US
Practice Address - Phone:707-600-3720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107352106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist