Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY00001481 | WA |
N | 103TC0700X | Clinical Psychologist | PY00001481 | WA |
N | 103TH0100X | Health Service | PY00001481 | WA |
NPI | 1548370760 |
---|---|
Provider Name | Dr. Maryjean Mariano |
First Address | Seattle, WA 98108-1532 |
Second Address | Seattle, WA 98108-1532 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |