Provider Demographics
NPI:1043235633
Name:SADOFF, MARC JEFFERY (MSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:JEFFERY
Last Name:SADOFF
Suffix:
Gender:M
Credentials:MSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 CORINTH AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1650
Mailing Address - Country:US
Mailing Address - Phone:310-444-1951
Mailing Address - Fax:
Practice Address - Street 1:2211 CORINTH AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1650
Practice Address - Country:US
Practice Address - Phone:310-444-1951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS117251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW11725AMedicare ID - Type Unspecified