Provider Demographics
NPI:1770878795
Name:DENN, MARTIN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:DENN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:738 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-3455
Mailing Address - Country:US
Mailing Address - Phone:310-874-9493
Mailing Address - Fax:310-545-6339
Practice Address - Street 1:738 33RD ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-3455
Practice Address - Country:US
Practice Address - Phone:310-545-9412
Practice Address - Fax:310-545-6339
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPYS23480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist