Marvin Behavioral Health Wi PC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MARVIN BEHAVIORAL HEALTH WI PC

Practice address

4136 Del Rey Ave Ste 626
Marina del Rey, CA 90292-5604

Phone

(617) 249-6854

NPI assigned

Oct 12, 2021

Organization subpart

No

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

Authorized official

Name

Kassie Claughton, LICSW

Title

President

Phone

(617) 249-6854

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1497417943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4136 DEL REY AVE STE 626",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925604"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4136 DEL REY AVE STE 626",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925604",
            "telephone_number": "617-249-6854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARVIN BEHAVIORAL HEALTH WI PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-12",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "CLAUGHTON",
        "authorized_official_first_name": "KASSIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "617-249-6854",
        "authorized_official_credential": "LICSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Counseling",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corina Martinez
• Lydiesther Martinez, MD
• Marvin Behavioral Health Ca PC
• Marvin Behavioral Health Inc
• Marvin Behavioral Health NJ PC
• Shamim Mashhadi
• Erika Matczenko
• Tamara Matevosyan, D.D.S.
• Andrea Mathieux
• Ian Maxwell Matthews, PMHNP

• Psychologist in Marina del Rey, CA
• Providers in Marina del Rey, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; 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.