Provider Demographics
NPI:1891947511
Name:MARHOLZ, JODIE (MRAS,MA,LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODIE
Middle Name:
Last Name:MARHOLZ
Suffix:
Gender:F
Credentials:MRAS,MA,LCSW
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:
Other - Last Name:KIRNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:24050 MADISON ST'
Mailing Address - Street 2:217
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3523
Mailing Address - Country:US
Mailing Address - Phone:310-463-6638
Mailing Address - Fax:310-373-5464
Practice Address - Street 1:24050 MADISON ST'
Practice Address - Street 2:217
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3523
Practice Address - Country:US
Practice Address - Phone:310-463-6638
Practice Address - Fax:310-373-5464
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW772371041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical