Provider Demographics
NPI:1760645998
Name:MARIONI, ANKHESENAMUN BALL (PSYD)
Entity Type:Individual
Prefix:
First Name:ANKHESENAMUN
Middle Name:BALL
Last Name:MARIONI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANKHESENAMUN
Other - Middle Name:
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1918 BONITA AVE # 200
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1014
Mailing Address - Country:US
Mailing Address - Phone:510-269-7607
Mailing Address - Fax:
Practice Address - Street 1:600 GRAND AVE STE 301
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-3548
Practice Address - Country:US
Practice Address - Phone:510-269-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TF0200X
CA24781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty