Provider Demographics
NPI:1568491371
Name:MARON, MARLENE TAMAR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:TAMAR
Last Name:MARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:PATRICK 405
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-4880
Mailing Address - Fax:802-847-8961
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:PATRICK 405
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4880
Practice Address - Fax:802-847-8961
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT048-0000536103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1003673Medicaid
VT1003673Medicaid