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General NPI Number Information
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NPI Number | 1912043233
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Entity Type | Organization
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Legal Business Name | MARINA PSYCHOLOGICAL SERVICES
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4640 ADMIRALTY WAY SUITE 318
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6621
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Country | US
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Telephone | 310-822-0109
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Fax | 310-822-1240
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Provider Business Mailing Address
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Address Line | 4640 ADMIRALTY WAY SUITE 318
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6621
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Country | US
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Telephone | 310-822-0109
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Fax | 310-822-1240
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Authorized Official
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Title or Position | CEO
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Name | STUART M SHAFFER
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Credential | PH.D.
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Telephone | 310-822-0109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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