Healthcare Provider Details

I. General information

NPI: 1154345726
Provider Name (Legal Business Name): TERRA F MARZANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 GREGORY ST W
UNIVERSITY PLACE WA
98466-5847
US

IV. Provider business mailing address

6402 GREGORY ST W
UNIVERSITY PLACE WA
98466-5847
US

V. Phone/Fax

Practice location:
  • Phone: 503-522-1116
  • Fax:
Mailing address:
  • Phone: 503-522-1116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL6495
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61230180
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: