Provider Demographics
NPI:1417342643
Name:MARZIANO, VINCENT (PHD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:MARZIANO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 GRAND AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-5365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2130 GRAND AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-5365
Practice Address - Country:US
Practice Address - Phone:515-650-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001269103TF0200X
IA000622103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service