MEDICARE: MARNI GLICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	117104	CA

General Provider Information

NPI Number	:	1083253751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARNI GLICK

Provider Business Mailing Address
First Line	:	11712 MOORPARK ST STE 211
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2164
Country	:	US
Telephone Number	:	818-875-0124
Fax Number	:

Provider Business Practice Location Address
First Line	:	11712 MOORPARK ST STE 211
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2164
Country	:	US
Telephone Number	:	818-875-0124
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	07/14/2021

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Directions to “ MARNI GLICK ” Practice Location

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