Healthcare Provider Details

I. General information

NPI: 1528536877
Provider Name (Legal Business Name): MARNIE KAGAN WESTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CABRILLO HWY S STE 208C
HALF MOON BAY CA
94019-7200
US

IV. Provider business mailing address

PO BOX 165
EL GRANADA CA
94018-0165
US

V. Phone/Fax

Practice location:
  • Phone: 650-867-7126
  • Fax: 833-211-2467
Mailing address:
  • Phone: 650-867-7126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY30357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: