Provider Demographics
NPI:1306930003
Name:SAVLOV, MARVIN ROBERT SR (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:ROBERT
Last Name:SAVLOV
Suffix:SR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 ORCHARD CREEK LANE
Mailing Address - Street 2:SU 304
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648
Mailing Address - Country:US
Mailing Address - Phone:916-390-0083
Mailing Address - Fax:916-408-2004
Practice Address - Street 1:945 ORCHARD CREEK LANE
Practice Address - Street 2:SU 304
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648
Practice Address - Country:US
Practice Address - Phone:916-390-0083
Practice Address - Fax:916-408-2004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS38781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25681ZMedicare ID - Type UnspecifiedMEDICARE IDENTIFICATION