MEDICARE: MARLENE W. VALTER, PSYD

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	305S00000X	Point of Service	PSY17095	CA

General Provider Information

NPI Number	:	1811422488
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLENE W. VALTER, PSYD

Provider Business Mailing Address
First Line	:	2625 TOWNSGATE RD
Second Line	:	SUITE 330
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5751
Country	:	US
Telephone Number	:	805-813-3774
Fax Number	:	805-531-0021

Provider Business Practice Location Address
First Line	:	2625 TOWNSGATE RD
Second Line	:	SUITE 330
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91361-5751
Country	:	US
Telephone Number	:	805-813-3774
Fax Number	:	805-531-0021

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARLENE W VALTER
Credential	:	PSYD
Telephone Number	:	805-813-3774

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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