Provider Demographics
NPI:1508855008
Name:KING, MARIE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:KING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4305 TORRANCE BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4409
Mailing Address - Country:US
Mailing Address - Phone:310-371-0197
Mailing Address - Fax:310-868-2593
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-371-0197
Practice Address - Fax:310-868-2593
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9813103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP9813Medicare ID - Type Unspecified