Provider Demographics
NPI:1831310028
Name:SPIKE, MARSHA SHARON (LCSW LIC CLIN SOC WO)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:SHARON
Last Name:SPIKE
Suffix:
Gender:F
Credentials:LCSW LIC CLIN SOC WO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19634 VENTURA BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-346-4772
Mailing Address - Fax:818-705-6849
Practice Address - Street 1:19634 VENTURA BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-346-4772
Practice Address - Fax:818-705-6849
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS56481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS5648OtherSTATE LIC NUMBER
SW5648Medicare ID - Type Unspecified