Provider Demographics
NPI:1851462311
Name:DANIELS, MARCIA LEIBOVITCH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LEIBOVITCH
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:MARCIA
Other - Middle Name:FAYE
Other - Last Name:LEIBOVITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:STE 805
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2637
Mailing Address - Country:US
Mailing Address - Phone:818-995-7848
Mailing Address - Fax:818-385-1278
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:STE 805
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2637
Practice Address - Country:US
Practice Address - Phone:818-995-7848
Practice Address - Fax:818-385-1278
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG400732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40073Medicare PIN
EO2643Medicare UPIN