Provider Demographics
NPI:1669297719
Name:LIMA, MARIAN LEE
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:LEE
Last Name:LIMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:LEE
Other - Last Name:MANGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1911 DOUGLAS BLVD # 85-250
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3811
Mailing Address - Country:US
Mailing Address - Phone:916-521-5467
Mailing Address - Fax:
Practice Address - Street 1:1911 DOUGLAS BLVD # 85-250
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3811
Practice Address - Country:US
Practice Address - Phone:916-521-5467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1136871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical