Healthcare Provider Details

I. General information

NPI: 1790357697
Provider Name (Legal Business Name): JULIE B MARINER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 OVERLOOK DR
MC MURRAY PA
15317-2657
US

IV. Provider business mailing address

221 OVERLOOK DR
MC MURRAY PA
15317-2657
US

V. Phone/Fax

Practice location:
  • Phone: 724-255-6413
  • Fax:
Mailing address:
  • Phone: 724-255-6413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC013440
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: