Healthcare Provider Details

I. General information

NPI: 1811028111
Provider Name (Legal Business Name): MARC SCHOEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10444 SANTA MONICA BLVD STE 303
LOS ANGELES CA
90025
US

IV. Provider business mailing address

10444 SANTA MONICA BLVD STE 303
LOS ANGELES CA
90025-5057
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-9545
  • Fax:
Mailing address:
  • Phone: 310-289-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7817
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY-7817
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPSY-7817
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY7817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: