Healthcare Provider Details

I. General information

NPI: 1053348573
Provider Name (Legal Business Name): DEONNE J VARRIANO LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2624 9TH AVE S
FARGO ND
58103-2350
US

IV. Provider business mailing address

2624 9TH AVE S
FARGO ND
58103-2350
US

V. Phone/Fax

Practice location:
  • Phone: 701-298-4500
  • Fax: 701-298-4400
Mailing address:
  • Phone: 701-298-4500
  • Fax: 701-298-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberND 751
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier016084
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBCBS OF ND PIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: