MEDICARE: STUART L ZUBRICK MARRIAGE FAMILY AND CHILD COUNSELING A PROF CORP

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	103TC0700X	Clinical Psychologist
2	103TC0700X	Clinical Psychologist	PSY7352	CA

General Provider Information

NPI Number	:	1326222019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STUART L ZUBRICK MARRIAGE FAMILY AND CHILD COUNSELING A PROF CORP

Provider Business Mailing Address
First Line	:	3435 WILSHIRE BLVD
Second Line	:	STE. 2700-80
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1901
Country	:	US
Telephone Number	:	213-739-0019
Fax Number	:	213-739-0091

Provider Business Practice Location Address
First Line	:	3435 WILSHIRE BLVD
Second Line	:	STE. 2700-80
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1901
Country	:	US
Telephone Number	:	213-739-0019
Fax Number	:	213-739-0091

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	STUART L ZUBRICK
Credential	:	PH.D.
Telephone Number	:	213-739-0019

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	10/31/2016

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