Provider Demographics
NPI:1033150594
Name:VAN ENK, MARC ALEXANDER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ALEXANDER
Last Name:VAN ENK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3703 LONG BEACH BLVD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3309
Mailing Address - Country:US
Mailing Address - Phone:562-400-2233
Mailing Address - Fax:562-595-8189
Practice Address - Street 1:3703 LONG BEACH BLVD
Practice Address - Street 2:SUITE D1
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3309
Practice Address - Country:US
Practice Address - Phone:562-400-2233
Practice Address - Fax:562-595-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY20449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC348ZMedicare PIN