Provider Demographics
NPI:1164590469
Name:BEITNER, MARVIN S (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:S
Last Name:BEITNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6226 E SPRING ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1423
Mailing Address - Country:US
Mailing Address - Phone:562-421-6715
Mailing Address - Fax:562-429-4556
Practice Address - Street 1:6226 E SPRING ST
Practice Address - Street 2:SUITE 260
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1423
Practice Address - Country:US
Practice Address - Phone:562-421-6715
Practice Address - Fax:562-429-4556
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY1036103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY010361Medicaid
CACP1031Medicare ID - Type UnspecifiedMEDICARE F.V.
CAPSY010361Medicaid
CACP1036Medicare ID - Type UnspecifiedMEDICARE NUMBER