Provider Demographics
NPI:1013408731
Name:LARIVIERE, MARISE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARISE
Middle Name:
Last Name:LARIVIERE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2558 N CATALINA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1133
Mailing Address - Country:US
Mailing Address - Phone:415-320-2589
Mailing Address - Fax:
Practice Address - Street 1:4448 AMBROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-2115
Practice Address - Country:US
Practice Address - Phone:323-609-3672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAATCB17430221700000X
CALMFT106273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist