Provider Demographics
NPI:1497200984
Name:IURCOVICH, MARIANA (PSYCHOTHERAPIST)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:IURCOVICH
Suffix:
Gender:F
Credentials:PSYCHOTHERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3132 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1324
Mailing Address - Country:US
Mailing Address - Phone:303-359-4414
Mailing Address - Fax:888-299-3741
Practice Address - Street 1:3132 29TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1324
Practice Address - Country:US
Practice Address - Phone:303-359-4414
Practice Address - Fax:888-299-3741
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONLC. 0106637103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth