Healthcare Provider Details

I. General information

NPI: 1861644551
Provider Name (Legal Business Name): MARC A. VAN ENK, PSYD, A PSYCHOLOGICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 LONG BEACH BLVD SUITE D1
LONG BEACH CA
90807-3309
US

IV. Provider business mailing address

3703 LONG BEACH BLVD SUITE D1
LONG BEACH CA
90807-3309
US

V. Phone/Fax

Practice location:
  • Phone: 562-400-2233
  • Fax:
Mailing address:
  • Phone: 562-400-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY20449
License Number StateCA

VIII. Authorized Official

Name: DR. MARC A VAN ENK
Title or Position: OWNER
Credential: PSYD
Phone: 562-400-2233