Provider Demographics
NPI:1316370505
Name:MARIANO, LOUISE L (LADAC)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:L
Last Name:MARIANO
Suffix:
Gender:F
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W NIZHONI BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-5766
Mailing Address - Country:US
Mailing Address - Phone:505-722-9470
Mailing Address - Fax:
Practice Address - Street 1:300 W NIZHONI BLVD STE A
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5766
Practice Address - Country:US
Practice Address - Phone:505-722-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)