Individual
MARISSA VELLICHOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
91-2301 OLD FT WEAVER RD, EWA BEACH, HI 96706-3602
(808) 542-0435
Mailing address
826 CAMINO REAL UNIT 201, REDONDO BEACH, CA 90277-4329
(808) 542-0435
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
ASW28692
CA
1041C0700X
Clinical Social Worker
Primary
4706
HI
1041C0700X
Clinical Social Worker
70022
CA
Other
Enumeration date
09/24/2009
Last updated
07/22/2024
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