Provider Demographics
NPI:1609911627
Name:RICHETTA, MARIAN J (MFT)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:J
Last Name:RICHETTA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3262 HOLIDAY CT
Mailing Address - Street 2:STE. 220
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0026
Mailing Address - Country:US
Mailing Address - Phone:858-587-1095
Mailing Address - Fax:858-450-1161
Practice Address - Street 1:3262 HOLIDAY CT
Practice Address - Street 2:STE. 220
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0026
Practice Address - Country:US
Practice Address - Phone:858-587-1095
Practice Address - Fax:858-450-1161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC17543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist