Provider Demographics
NPI:1386469716
Name:OSCARSON, MARIAH
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:OSCARSON
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 1:6285 E SPRING ST # 583
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4020
Mailing Address - Country:US
Mailing Address - Phone:562-916-6942
Mailing Address - Fax:
Practice Address - Street 1:19321 GROVE COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-8113
Practice Address - Country:US
Practice Address - Phone:562-916-6942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist