Provider Demographics
NPI:1649726365
Name:RILEY, MARISSA MIKAL
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:MIKAL
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 RAFT LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1740
Mailing Address - Country:US
Mailing Address - Phone:805-607-9538
Mailing Address - Fax:
Practice Address - Street 1:801 RAFT LANE
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035
Practice Address - Country:US
Practice Address - Phone:805-607-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health