Provider Demographics
NPI:1518469634
Name:PADILLA, MARISA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PADILLA
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 1:325 W WASHINGTON STREET
Mailing Address - Street 2:SUITE 2- 912
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3812
Mailing Address - Country:US
Mailing Address - Phone:510-449-5415
Mailing Address - Fax:
Practice Address - Street 1:325 W WASHINGTON STREET
Practice Address - Street 2:SUITE 2- 912
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3812
Practice Address - Country:US
Practice Address - Phone:619-268-1061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA136357101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator