Provider Demographics
NPI:1992839369
Name:BOCHKUR-DRATVER, MARINA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:BOCHKUR-DRATVER
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:PO BOX 1870
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91614-0870
Mailing Address - Country:US
Mailing Address - Phone:818-730-7415
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:818-730-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health