Provider Demographics
NPI:1750641395
Name:MAMAN, RISHELLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RISHELLE
Middle Name:
Last Name:MAMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2814
Mailing Address - Country:US
Mailing Address - Phone:310-729-9922
Mailing Address - Fax:
Practice Address - Street 1:1455 ROXBURY DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2814
Practice Address - Country:US
Practice Address - Phone:310-729-9922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA206591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical