Provider Demographics
NPI:1780896175
Name:MOTT, MARIAM (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIAM
Middle Name:
Last Name:MOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28562 OSO PKWY
Mailing Address - Street 2:SUITE D-437
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5595
Mailing Address - Country:US
Mailing Address - Phone:949-858-6688
Mailing Address - Fax:949-858-6986
Practice Address - Street 1:31371 RANCHO VIEJO RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1849
Practice Address - Country:US
Practice Address - Phone:949-858-6688
Practice Address - Fax:949-858-6986
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY16181103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent