Provider Demographics
NPI:1255356382
Name:MEGIBOW, MARVIN (PHD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:MEGIBOW
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 1:1660 HUMBOLDT RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9199
Mailing Address - Country:US
Mailing Address - Phone:530-343-2075
Mailing Address - Fax:
Practice Address - Street 1:1660 HUMBOLDT RD STE 3
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9199
Practice Address - Country:US
Practice Address - Phone:530-343-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9566103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS06085Medicare UPIN