Healthcare Provider Details

I. General information

NPI: 1053215624
Provider Name (Legal Business Name): MARAM MANASRAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 INDIANA AVE STE 150
RIVERSIDE CA
92506-4286
US

IV. Provider business mailing address

6800 INDIANA AVE STE 150
RIVERSIDE CA
92506-4286
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-6684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20529
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number158172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: