Provider Demographics
NPI:1528536877
Name:WESTON, MARNIE KAGAN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARNIE
Middle Name:KAGAN
Last Name:WESTON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:EL GRANADA
Mailing Address - State:CA
Mailing Address - Zip Code:94018-0165
Mailing Address - Country:US
Mailing Address - Phone:650-867-7126
Mailing Address - Fax:
Practice Address - Street 1:225 CABRILLO HWY S STE 208C
Practice Address - Street 2:
Practice Address - City:HALF MOON BAY
Practice Address - State:CA
Practice Address - Zip Code:94019-7200
Practice Address - Country:US
Practice Address - Phone:650-867-7126
Practice Address - Fax:833-211-2467
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical