Provider Demographics
NPI:1982201596
Name:GANESH, MARJA (AMFT/APCC)
Entity Type:Individual
Prefix:
First Name:MARJA
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:AMFT/APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE #302
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-787-6676
Mailing Address - Fax:
Practice Address - Street 1:3737 CAMINO DEL RIO S
Practice Address - Street 2:SUITE #302
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-787-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8098101YP2500X
CA119952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional