Provider Demographics
NPI:1538267455
Name:MARIANO, ERIC J (PHD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:MARIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:VANTHCS (116A)
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:214-857-0835
Mailing Address - Fax:214-857-0902
Practice Address - Street 1:4500 S LANCASTER RD
Practice Address - Street 2:VANTHCS (116A)
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-7167
Practice Address - Country:US
Practice Address - Phone:214-857-0835
Practice Address - Fax:214-857-0902
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical