Provider Demographics
NPI:1407463201
Name:MARDEN, CONNOR JAY
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:JAY
Last Name:MARDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:838 S MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2408
Mailing Address - Country:US
Mailing Address - Phone:831-754-3635
Mailing Address - Fax:
Practice Address - Street 1:838 S MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2408
Practice Address - Country:US
Practice Address - Phone:831-754-3635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health