Provider Demographics
NPI:1689830952
Name:SANDERS, MARC CRAIG (PHD, FIPA)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:CRAIG
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PHD, FIPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N BEDFORD DR STE 407
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5122
Mailing Address - Country:US
Mailing Address - Phone:310-497-5995
Mailing Address - Fax:
Practice Address - Street 1:1990 S BUNDY DR STE 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5249
Practice Address - Country:US
Practice Address - Phone:310-990-0988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 18365103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist