Provider Demographics
NPI:1831484229
Name:KARAM-WIJELATH, MARINA (MFTI)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KARAM-WIJELATH
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:KARAM-WIJELATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:3626 BALBOA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121
Mailing Address - Country:US
Mailing Address - Phone:415-668-5955
Mailing Address - Fax:415-668-0246
Practice Address - Street 1:3626 BALBOA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-2604
Practice Address - Country:US
Practice Address - Phone:415-668-5955
Practice Address - Fax:415-668-0246
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1831484229OtherMARRIAGE & FAMILY THERAPIST INTERN