Provider Demographics
NPI:1710776323
Name:MARILISA RAJU, PHD PSYCHOLOGIST, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARILISA RAJU, PHD PSYCHOLOGIST, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILISA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-206-5219
Mailing Address - Street 1:12625 FREDERICK STREET
Mailing Address - Street 2:ST #I5-150
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553
Mailing Address - Country:US
Mailing Address - Phone:909-206-5219
Mailing Address - Fax:
Practice Address - Street 1:2447 PACIFIC COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2714
Practice Address - Country:US
Practice Address - Phone:909-206-5219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-01
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty