Provider Demographics
NPI:1326282021
Name:MARUYAMA, SAORI (PHD)
Entity Type:Individual
Prefix:
First Name:SAORI
Middle Name:
Last Name:MARUYAMA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10475 MEDLOCK BRIDGE RD
Mailing Address - Street 2:BUILDING 300, SUITE 315
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4433
Mailing Address - Country:US
Mailing Address - Phone:678-935-9567
Mailing Address - Fax:678-935-9568
Practice Address - Street 1:10475 MEDLOCK BRIDGE RD
Practice Address - Street 2:BUILDING 300, SUITE 315
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4433
Practice Address - Country:US
Practice Address - Phone:678-935-9567
Practice Address - Fax:678-935-9568
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003255103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical