Provider Demographics
NPI:1457712085
Name:ORLY MARMUR PSYCHOLOGICAL CORP
Entity Type:Organization
Organization Name:ORLY MARMUR PSYCHOLOGICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ORLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARMUR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:818-231-0008
Mailing Address - Street 1:5361 VELOZ AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4127
Mailing Address - Country:US
Mailing Address - Phone:818-231-0008
Mailing Address - Fax:818-401-9903
Practice Address - Street 1:5361 VELOZ AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4127
Practice Address - Country:US
Practice Address - Phone:818-231-0008
Practice Address - Fax:818-401-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27553103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty