Provider Demographics
NPI:1982814604
Name:SHATZ, MARC (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:
Last Name:SHATZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SOUTH LASKY DRIVE
Mailing Address - Street 2:PENTHOUSE SUITE
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212
Mailing Address - Country:US
Mailing Address - Phone:310-274-9200
Mailing Address - Fax:310-446-6648
Practice Address - Street 1:152 S LASKY DR
Practice Address - Street 2:PENTHOUSE SUITE
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1720
Practice Address - Country:US
Practice Address - Phone:310-274-9200
Practice Address - Fax:310-446-6648
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY#4257102L00000X, 103TA0400X, 103TC0700X, 103TC1900X, 103TF0000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist