Provider Demographics
NPI:1780696724
Name:MARCIANO, SUSAN T (PHD, LISW-CP)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:T
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:PHD, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 ASSEMBLY ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2142
Mailing Address - Country:US
Mailing Address - Phone:803-736-1891
Mailing Address - Fax:803-736-1368
Practice Address - Street 1:2016 ASSEMBLY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2142
Practice Address - Country:US
Practice Address - Phone:803-736-1891
Practice Address - Fax:803-736-1368
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0056521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical