Provider Demographics
NPI:1598213142
Name:AGRIESTI, MARLANE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARLANE
Middle Name:
Last Name:AGRIESTI
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 1:7742 HERSCHEL AVE STE K
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4444
Mailing Address - Country:US
Mailing Address - Phone:858-247-2925
Mailing Address - Fax:
Practice Address - Street 1:7742 HERSCHEL AVE STE K
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4444
Practice Address - Country:US
Practice Address - Phone:858-247-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134004106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA15826673OtherCAQH ID