Provider Demographics
NPI:1467984286
Name:MARIAN, GINA (MSED, BCBA/LABA)
Entity Type:Individual
Prefix:MRS
First Name:GINA
Middle Name:
Last Name:MARIAN
Suffix:
Gender:F
Credentials:MSED, BCBA/LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SALINA RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02122-3314
Mailing Address - Country:US
Mailing Address - Phone:617-513-6566
Mailing Address - Fax:
Practice Address - Street 1:34 SALINA RD
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02122-3314
Practice Address - Country:US
Practice Address - Phone:617-513-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA405103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst