Provider Demographics
NPI:1750968756
Name:BARAJAS, MARISSA NICOLE
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:NICOLE
Last Name:BARAJAS
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 1:8424 GLIDER AVE
Mailing Address - Street 2:
Mailing Address - City:WESTCHESTER
Mailing Address - State:CA
Mailing Address - Zip Code:90045-4221
Mailing Address - Country:US
Mailing Address - Phone:909-996-6362
Mailing Address - Fax:
Practice Address - Street 1:2401 PACIFIC COAST HWY STE 106
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2734
Practice Address - Country:US
Practice Address - Phone:424-209-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA158576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist