MEDICARE: MARISA DAGENHART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1255045894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA DAGENHART

Provider Business Mailing Address
First Line	:	PO BOX 7524
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92552-7524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 7524
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92552-7524
Country	:	US
Telephone Number	:	951-956-9229
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2023
Last Update Date	:	03/23/2025

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Directions to “ MARISA DAGENHART ” Practice Location

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