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General NPI Number Information
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NPI Number | 1932486438
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Entity Type | Individual
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Provider Name | KIMBERLY SPITZ MARES PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 02/06/2014
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Provider Practice Location Address
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Address Line | 110 N MACLAY AVE SUITE 110
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2989
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Country | US
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Telephone | 818-365-3660
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Fax | 818-365-3661
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Provider Business Mailing Address
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Address Line | 110 N MACLAY AVE SUITE 110
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City | SAN FERNANDO
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State | CA
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Zip | 91340-2989
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Country | US
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Telephone | 818-365-3660
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Fax | 818-365-3661
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 24634
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License Number State | CA
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