Provider Demographics
NPI:1922664960
Name:MARSH, CECELIA
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 BOLLINGER CANYON ROAD
Mailing Address - Street 2:ST E#155
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582
Mailing Address - Country:US
Mailing Address - Phone:925-915-0610
Mailing Address - Fax:
Practice Address - Street 1:11040 BOLLINGER CANYON ROAD
Practice Address - Street 2:ST E#155
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582
Practice Address - Country:US
Practice Address - Phone:925-915-0610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician