Active NPI
Susan Marckx, MFT
- Marriage & Family Therapist
- Canoga Park, CA
National Provider Identifier
1790987626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFT35510
- Practice address
- 22115 Roscoe Blvd
Canoga Park, CA 91304 - Phone
- (818) 884-8100
- NPI assigned
- Jun 4, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFT35510 | CA | Primary |
Addresses
Primary practice location
22115 Roscoe Blvd
Canoga Park, CA 91304
Mailing address
18757 Burbank Blvd
Suite 130
Tarzana, CA 91356
Phone (818) 345-8355
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7484 | Medicaid | CA | |
| 7283 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective May 13, 2024 through May 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFT35510 | CA | MD | Marriage & Family Therapist |
| 35510 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| FH 7 HF - Torrance I, LLC | Past | Accepting new patients | |
| Sunnyside Nursing Center | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Sunnyside Residential
- Mental Illness Community Based Residential Treatment Facility
- Torrance, CA
- NPI 1124243886
-
- Skilled Nursing Facility
- Torrance, CA
- NPI 1679798086
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1790987626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18757 BURBANK BLVD",
"address_2": "SUITE 130",
"city": "TARZANA",
"state": "CA",
"postal_code": "91356",
"telephone_number": "818-345-8355",
"fax_number": "818-345-8755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22115 ROSCOE BLVD",
"city": "CANOGA PARK",
"state": "CA",
"postal_code": "91304",
"telephone_number": "818-884-8100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCKX",
"first_name": "SUSAN",
"credential": "MFT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFT35510",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7484",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7283",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Canoga Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.