Doctor Name: | DR. JOHN MATTHEW MARIANI |
NPI Number: | 1003243866 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PSY.D. |
License Number: | 002569 |
Business Practice Address: | 200 Main St Manchester, CT - 060423581 |
Business Phone Number: | 8606469660 |
Business Fax Number: | 8606434704 |
Mailing Address: | 200 Main St, MANCHESTER |
State: | CT |
Postal Code: | 060423581 |
Phone Number: | 8606469660 |
Fax Number: | 8606434704 |
NPI Enumeration Date: | 10/10/2013 |
NPI Last Update Date: | 10/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 002569 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |