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NPI Code Detail

MEDICARE: MARIANNA BIRDSONG

MEDICARE: MARIANNA BIRDSONG
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
1101YM0800XMental Health CounselorCA
21041C0700XClinical Social Worker119127CA

General Provider Information

NPI Number : 1992176788
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIANNA BIRDSONG
Provider Business Mailing Address
First Line : 2085 RUSTIN AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2498
Country : US
Telephone Number : 951-715-5040
Fax Number :
Provider Business Practice Location Address
First Line : 1405 SPRUCE ST STE A
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-2410
Country : US
Telephone Number : 951-715-5040
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2015
Last Update Date : 12/06/2023

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Directions to “ MARIANNA BIRDSONG ” Practice Location

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