Provider Demographics
NPI:1366625568
Name:MARZ, GERALDINE LOUISE (MA)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:LOUISE
Last Name:MARZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-3054
Mailing Address - Country:US
Mailing Address - Phone:814-397-3258
Mailing Address - Fax:814-860-8606
Practice Address - Street 1:3505 CHAPIN ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2773
Practice Address - Country:US
Practice Address - Phone:814-397-3258
Practice Address - Fax:814-860-8606
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004222L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist