Provider Demographics
NPI:1760663066
Name:PETRIE, MARDEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARDEN
Middle Name:
Last Name:PETRIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11114 N FALLING RAIN RD
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7321
Mailing Address - Country:US
Mailing Address - Phone:520-488-4602
Mailing Address - Fax:888-429-6085
Practice Address - Street 1:6592 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5640
Practice Address - Country:US
Practice Address - Phone:520-488-4602
Practice Address - Fax:888-429-6085
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4231103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical