1932142577 NPI number — MS. MELINDA J MARIANO MS-CCCSLP

Table of content: MS. MELINDA J MARIANO MS-CCCSLP (NPI 1932142577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932142577 NPI number — MS. MELINDA J MARIANO MS-CCCSLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARIANO
Provider First Name:
MELINDA
Provider Middle Name:
J
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS-CCCSLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932142577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 142
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHFIELD
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05663-0142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-371-9086
Provider Business Mailing Address Fax Number:
802-485-9660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
749 ROUTE 12 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHFIELD
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05663-0142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-371-9086
Provider Business Practice Location Address Fax Number:
802-485-9660
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  12062116 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SA8296 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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