Provider Demographics
NPI:1568516797
Name:PARKER, MARIAN JOYCE (PHD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:JOYCE
Last Name:PARKER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:11231 PLATTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-2243
Mailing Address - Country:US
Mailing Address - Phone:951-789-4410
Mailing Address - Fax:951-789-9169
Practice Address - Street 1:17675 VAN BUREN BLVD STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-6076
Practice Address - Country:US
Practice Address - Phone:951-789-4410
Practice Address - Fax:951-789-9169
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PSY 12724103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist