Healthcare Provider Details

I. General information

NPI: 1881789501
Provider Name (Legal Business Name): MARIANNA ADLER PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WEST 38TH ST., SUITE 49
AUSTIN TX
78731-6301
US

IV. Provider business mailing address

1500 WEST 38TH ST., SUITE 49
AUSTIN TX
78731-6301
US

V. Phone/Fax

Practice location:
  • Phone: 512-453-9225
  • Fax: 512-453-7899
Mailing address:
  • Phone: 512-453-9225
  • Fax: 512-453-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number30849
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: