Provider Demographics
NPI:1104198514
Name:DAVIES, MARI SIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:SIAN
Last Name:DAVIES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5230 PACIFIC CONCOURSE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6200
Mailing Address - Country:US
Mailing Address - Phone:310-643-9595
Mailing Address - Fax:310-643-5180
Practice Address - Street 1:4640 ADMIRALTY WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6621
Practice Address - Country:US
Practice Address - Phone:650-479-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-31
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24383PSY103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist