Marvin Wade Altom, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY 24619 Issued in CA

Practice address

5014 Chesebro Rd FL 2
Agoura Hills, CA 91301-2278

Phone

(818) 707-7366

NPI assigned

Jan 11, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Psychological Services Inc

  • Psychologist
  • Agoura Hills, CA
  • NPI 1881746733
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357862400000",
    "number": "1457698359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13676 SHENANDOAH WAY",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930211262",
            "telephone_number": "805-341-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5014 CHESEBRO RD FL 2",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913012278",
            "telephone_number": "818-707-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALTOM",
        "first_name": "MARVIN",
        "middle_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-11",
        "last_updated": "2013-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY 24619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aimee E. Anderson, PH.D. a Professional Psychology Corporation
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• Nimira Samir Alibhoy, DC
• Irit Almog, MA, LMFT
• American Home Health
• Aminzadeh and Ahmadpour Medical Corporaiton
• Ample Home Health, Inc.
• Andrea S. Arons DDS, a Professional Dental Corporation
• Abanob Anis

• Clinical Psychologist in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.