Healthcare Provider Details

I. General information

NPI: 1619312030
Provider Name (Legal Business Name): SARAH E MARVIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

760 WESTWOOD PLZ
LOS ANGELES CA
90024-5055
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-2836
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25536
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: