Provider Demographics
NPI:1912013285
Name:VAZIRI, MARCIA J
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:J
Last Name:VAZIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 S TAMARAC DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4394
Mailing Address - Country:US
Mailing Address - Phone:303-597-7777
Mailing Address - Fax:303-597-7700
Practice Address - Street 1:3201 S TAMARAC DR
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4394
Practice Address - Country:US
Practice Address - Phone:303-597-7777
Practice Address - Fax:303-597-7700
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8667103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9147539Medicaid
COA0606Medicare ID - Type UnspecifiedGROUP