Provider Demographics
NPI:1427089358
Name:CARLIN, MAURY THEODORE I (PHD)
Entity type:Individual
Prefix:DR
First Name:MAURY
Middle Name:THEODORE
Last Name:CARLIN
Suffix:I
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 1:16311 VENTURA BLVD.
Mailing Address - Street 2:SUITE 1050
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4347
Mailing Address - Country:US
Mailing Address - Phone:818-783-3836
Mailing Address - Fax:818-783-3832
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 1050
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-783-3836
Practice Address - Fax:818-783-3832
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAUCP3068AMedicare PIN