Marcus Teissedre, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8627-C Issued in NV

Practice address

10725 Double R Blvd
Reno, NV 89521-8976

Phone

(775) 561-4328

NPI assigned

Jun 21, 2017

Last updated

Nov 18, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1498003200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1770003691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10725 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218976",
            "telephone_number": "775-561-4328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10725 DOUBLE R BLVD",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218976",
            "telephone_number": "775-561-4328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6490 S McCarran Blvd Unit 6",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "895096165",
            "country_code": "US",
            "telephone_number": "775-448-9760",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1240 East Ninth Street",
            "address_purpose": "LOCATION",
            "city": "Reno",
            "state": "NV",
            "postal_code": "89512",
            "country_code": "US",
            "telephone_number": "800-242-0478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TEISSEDRE",
        "first_name": "MARCUS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-21",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NV",
            "license": "7510-S",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "8627-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Reno, NV
• Providers in Reno, NV by specialty
• Clinical Social Worker in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.