Provider Demographics
NPI:1225355852
Name:MARKS-TARLOW, TERRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:MARKS-TARLOW
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 7TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2629
Mailing Address - Country:US
Mailing Address - Phone:310-458-3418
Mailing Address - Fax:
Practice Address - Street 1:1460 7TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2629
Practice Address - Country:US
Practice Address - Phone:310-458-3418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical