Marvin Behavioral Health Inc

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

MARVIN BEHAVIORAL HEALTH INC

Practice address

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

Phone

(617) 249-6854

NPI assigned

Nov 4, 2021

Last updated

May 31, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Bracaglia

Title

Ceo

Phone

(610) 937-2023

Specialties & licenses 6

Addresses

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

{
    "created_epoch": "1635984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1700541612",
    "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",
            "telephone_number": "617-249-6854"
        },
        {
            "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 INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-04",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "BRACAGLIA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "610-937-2023"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dontae Marshall
• Jordan Martin, MA, NCC, LPC
• Corina Martinez
• Lydiesther Martinez, MD
• Marvin Behavioral Health Ca PC
• Marvin Behavioral Health NJ PC
• Marvin Behavioral Health Wi PC
• Shamim Mashhadi
• Erika Matczenko
• Tamara Matevosyan, D.D.S.

• 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.