Provider Demographics
NPI:1003825290
Name:MARKS, MARI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6430 W SUNSET BLVD STE 1180
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-8029
Mailing Address - Country:US
Mailing Address - Phone:310-472-2523
Mailing Address - Fax:323-467-2308
Practice Address - Street 1:6430 W SUNSET BLVD STE 1180
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028
Practice Address - Country:US
Practice Address - Phone:310-472-2523
Practice Address - Fax:323-467-2308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP12536Medicare PIN