Provider Demographics
NPI:1861644551
Name:MARC A. VAN ENK, PSYD, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:MARC A. VAN ENK, PSYD, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAN ENK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:562-400-2233
Mailing Address - Street 1:3703 LONG BEACH BLVD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3309
Mailing Address - Country:US
Mailing Address - Phone:562-400-2233
Mailing Address - Fax:
Practice Address - Street 1:3703 LONG BEACH BLVD
Practice Address - Street 2:SUITE D1
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3309
Practice Address - Country:US
Practice Address - Phone:562-400-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20449103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC349AMedicare PIN