Provider Demographics
NPI:1083959910
Name:MCGARY, MARZETTE (MDIV)
Entity Type:Individual
Prefix:
First Name:MARZETTE
Middle Name:
Last Name:MCGARY
Suffix:
Gender:F
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1568 W 36TH PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-4503
Mailing Address - Country:US
Mailing Address - Phone:310-999-5756
Mailing Address - Fax:
Practice Address - Street 1:1568 W 36TH PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-4503
Practice Address - Country:US
Practice Address - Phone:310-999-5756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)