Provider Demographics
NPI:1134985278
Name:VELASCO-ADANIA, MARISSA (AMFT)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:VELASCO-ADANIA
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2615 CA-1
Mailing Address - Street 2:326
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254
Mailing Address - Country:US
Mailing Address - Phone:323-546-2753
Mailing Address - Fax:
Practice Address - Street 1:2615 CA-1
Practice Address - Street 2:SUITE 326
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254
Practice Address - Country:US
Practice Address - Phone:323-546-2753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist