Provider Demographics
NPI:1891119525
Name:SLATER, MARGIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARGIE
Middle Name:
Last Name:SLATER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 VENTURA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4153
Mailing Address - Country:US
Mailing Address - Phone:818-427-4096
Mailing Address - Fax:
Practice Address - Street 1:17000 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-4153
Practice Address - Country:US
Practice Address - Phone:818-427-4096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical