Individual provider Active NPI

Marvin Sanderson, LMFT 99394

  • Marriage & Family Therapist
  • Gardena, CA
National Provider Identifier
1962695627
Registry record updated Nov 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
99394 Issued in CA
Practice address
1045 W Redondo Beach Blvd FL 3
Gardena, CA 90247-4128
Phone
(323) 241-6730
NPI assigned
Aug 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X 99394 CA Primary

Addresses

Primary practice location

1045 W Redondo Beach Blvd FL 3
Gardena, CA 90247-4128

Mailing address

2311 W El Segundo Blvd
Hawthorne, CA 90250-3315
Phone (323) 241-6740

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231227002583 CA Practitioner - Marriage and Family Therapist 9638529027 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Los Angeles County Department of Mental HealthGroup PAC ID 7416869896, 294 clinicians

Practice addresses (Care Compare)

1045 W Redondo Beach Blvd
Gardena, CA 90247-4128
Phone (323) 241-6730

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
99394CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Los Angeles County Department of Mental Health Current Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jan 1, 2024 Accepting new patients
Los Angeles County Department of Mental Health CurrentSince Jan 1, 2024 Accepting new patients

Locations

1045 W Redondo Beach Blvd
Gardena, CA 90247
Phone (310) 329-1444

1045 W Redondo Beach Blvd
Fl 3
Gardena, CA 90247
Phone (310) 352-4170

10515 Balboa Blvd
Granada Hills, CA 91344
Phone (818) 486-3837

2311 W El Segundo Blvd
Hawthorne, CA 90250
Phone (310) 241-6730

510 S Vermont Ave
Fl 19
Los Angeles, CA 90020
Phone (213) 480-3416

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1962695627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2311 W EL SEGUNDO BLVD",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902503315",
            "telephone_number": "323-241-6740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 W REDONDO BEACH BLVD FL 3",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902474128",
            "telephone_number": "323-241-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERSON",
        "first_name": "MARVIN",
        "credential": "LMFT 99394",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-24",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "99394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

Verify at the official NPI Registry.