Provider Demographics
NPI:1487674099
Name:MAURY T.CARLIN,,PH.D,A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:MAURY T.CARLIN,,PH.D,A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURY
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:CARLIN
Authorized Official - Suffix:II
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-783-3836
Mailing Address - Street 1:16311 VENTURA BLVD,
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4347
Mailing Address - Country:US
Mailing Address - Phone:818-783-3836
Mailing Address - Fax:818-783-3832
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 1050
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-783-3836
Practice Address - Fax:818-783-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1427089358Medicare ID - Type UnspecifiedIINDIVIDUAL PROVIDER