Provider Demographics
NPI:1336235803
Name:DIPIETRO, MARISA (MFT, PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:DIPIETRO
Suffix:
Gender:F
Credentials:MFT, PSYD
Other - Prefix:DR
Other - First Name:MARISA
Other - Middle Name:DIPIETRO
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT, PSYD
Mailing Address - Street 1:420 S. BEVERLY DRIVE, #100
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-284-4884
Mailing Address - Fax:310-277-4202
Practice Address - Street 1:420 S. BEVERLY DRIVE, #100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212
Practice Address - Country:US
Practice Address - Phone:310-284-4884
Practice Address - Fax:310-277-4202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist