Provider Demographics
NPI:1487131595
Name:RIVERSIDE THERAPY GROUP
Entity type:Organization
Organization Name:RIVERSIDE THERAPY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:209-368-2532
Mailing Address - Street 1:18826 N LOWER SACRAMENTO RD STE C
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-9290
Mailing Address - Country:US
Mailing Address - Phone:209-368-2532
Mailing Address - Fax:209-625-0492
Practice Address - Street 1:18826 N LOWER SACRAMENTO RD STE C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CA
Practice Address - Zip Code:95258
Practice Address - Country:US
Practice Address - Phone:209-368-2532
Practice Address - Fax:209-625-0492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-20
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT54037261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093144198OtherNPPES