Healthcare Provider Details

I. General information

NPI: 1669811964
Provider Name (Legal Business Name): CATHY DIAN MARUTZKY MED, LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2013
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23030 LYONS AVE STE 205
SANTA CLARITA CA
91321-2755
US

IV. Provider business mailing address

4100 WATERVILLE CT
PALMDALE CA
93551-5383
US

V. Phone/Fax

Practice location:
  • Phone: 214-906-5513
  • Fax:
Mailing address:
  • Phone: 214-906-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4194
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCA3956
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: