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General NPI Number Information
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NPI Number | 1487383576
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Entity Type | Individual
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Provider Name | KHADEEJAH MAARIYAH BAAREE
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Gender | Female
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 3125 MYERS ST # 3
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City | RIVERSIDE
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State | CA
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Zip | 92503-5527
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Country | US
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Telephone | 909-223-7717
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 PRESLEY AVE
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City | RIVERSIDE
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State | CA
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Zip | 92507-4453
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Country | US
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Telephone | 951-955-0971
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CI3864052
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | CI3864052
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-AUQCTE
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License Number State | CA
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