Provider Demographics
NPI:1487722658
Name:NOVELL, MARTIN COLEMAN (MARRIAGE FAMILY THER)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:COLEMAN
Last Name:NOVELL
Suffix:
Gender:M
Credentials:MARRIAGE FAMILY THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 SAN VICENTE BLVD
Mailing Address - Street 2:MARTIN NOVELL UNIT G
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-1839
Mailing Address - Country:US
Mailing Address - Phone:310-250-4556
Mailing Address - Fax:310-451-7746
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-250-4556
Practice Address - Fax:310-451-7746
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist