Provider Demographics
NPI:1093962623
Name:MIDDLER, MARSHA SUSAN (MFT/PHD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:SUSAN
Last Name:MIDDLER
Suffix:
Gender:F
Credentials:MFT/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERATION WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0173
Mailing Address - Country:US
Mailing Address - Phone:949-435-3460
Mailing Address - Fax:714-445-4960
Practice Address - Street 1:1 FEDERATION WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-0173
Practice Address - Country:US
Practice Address - Phone:949-435-3460
Practice Address - Fax:714-445-4960
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC8631OtherMFC8631