Provider Demographics
NPI:1407997158
Name:DAVIDOFF, MARC (LMFT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:DAVIDOFF
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 F ST STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2822
Mailing Address - Country:US
Mailing Address - Phone:858-336-8507
Mailing Address - Fax:619-656-9306
Practice Address - Street 1:229 F ST STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2822
Practice Address - Country:US
Practice Address - Phone:858-336-8507
Practice Address - Fax:619-656-9306
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA49074103TB0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1407997158OtherBOARD OF BEHAVIROAL SCINCE ,