Healthcare Provider Details

I. General information

NPI: 1225408099
Provider Name (Legal Business Name): MARIAN EHRICH OPPENHEIMER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8838 W PICO BLVD
LOS ANGELES CA
90035-3302
US

IV. Provider business mailing address

1548 6TH ST APT 303
SANTA MONICA CA
90401-2887
US

V. Phone/Fax

Practice location:
  • Phone: 310-247-0534
  • Fax:
Mailing address:
  • Phone: 347-721-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberRPS2012568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: