Healthcare Provider Details

I. General information

NPI: 1982814604
Provider Name (Legal Business Name): MARC SHATZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 S LASKY DR PENTHOUSE SUITE
BEVERLY HILLS CA
90212-1720
US

IV. Provider business mailing address

152 SOUTH LASKY DRIVE PENTHOUSE SUITE
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-274-9200
  • Fax: 310-446-6648
Mailing address:
  • Phone: 310-274-9200
  • Fax: 310-446-6648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY#4257
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY#4257
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY#4257
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY#4257
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY#4257
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPSY#4257
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: