Healthcare Provider Details

I. General information

NPI: 1043696263
Provider Name (Legal Business Name): MARILYN R TERNAY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2015
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 E YALE AVE
DENVER CO
80222-6902
US

IV. Provider business mailing address

1 KALISA WAY STE 101
PARAMUS NJ
07652-3508
US

V. Phone/Fax

Practice location:
  • Phone: 888-948-6789
  • Fax: 877-345-3501
Mailing address:
  • Phone: 888-948-6789
  • Fax: 877-345-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0000837
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: