Healthcare Provider Details

I. General information

NPI: 1699319392
Provider Name (Legal Business Name): MARCIA NIMMER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2019
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 S BEVERLY DR # 100-17A
BEVERLY HILLS CA
90212-4426
US

IV. Provider business mailing address

420 S BEVERLY DR # 100-17A
BEVERLY HILLS CA
90212-4426
US

V. Phone/Fax

Practice location:
  • Phone: 424-646-3562
  • Fax:
Mailing address:
  • Phone: 424-646-3562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY31404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: