Provider Demographics
NPI:1821370941
Name:DALE, MARIAN E (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:E
Last Name:DALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CHRISTINE CT
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1201
Mailing Address - Country:US
Mailing Address - Phone:510-222-5738
Mailing Address - Fax:510-223-0838
Practice Address - Street 1:95 CHRISTINE CT
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1201
Practice Address - Country:US
Practice Address - Phone:510-222-5738
Practice Address - Fax:510-223-0838
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18257103TC0700X, 3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness