Provider Demographics
NPI:1477628923
Name:SLAVEN, MARGARET MARY (PSYD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:SLAVEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N HARBOR BLVD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-4126
Mailing Address - Country:US
Mailing Address - Phone:714-681-9070
Mailing Address - Fax:714-773-4788
Practice Address - Street 1:1400 N HARBOR BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4126
Practice Address - Country:US
Practice Address - Phone:714-681-9070
Practice Address - Fax:714-773-4788
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19346103G00000X, 103TC0700X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP19346Medicare ID - Type Unspecified