Provider Demographics
NPI:1366289050
Name:ALTER, MARILYN ANN
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ANN
Last Name:ALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 SAPPHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3635
Mailing Address - Country:US
Mailing Address - Phone:818-314-5880
Mailing Address - Fax:
Practice Address - Street 1:3930 SAPPHIRE DR
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3635
Practice Address - Country:US
Practice Address - Phone:818-437-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist