Healthcare Provider Details

I. General information

NPI: 1699347294
Provider Name (Legal Business Name): MARISSA HARTEL PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MEDA AVE STE 280
GLENDORA CA
91741-2691
US

IV. Provider business mailing address

150 E MEDA AVE STE 280
GLENDORA CA
91741-2691
US

V. Phone/Fax

Practice location:
  • Phone: 626-509-8785
  • Fax:
Mailing address:
  • Phone: 626-509-8785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: