Provider Demographics
NPI:1023135183
Name:SANZONE, MARLA M (PHD)
Entity type:Individual
Prefix:DR
First Name:MARLA
Middle Name:M
Last Name:SANZONE
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 1:104 ANNAPOLIS ST
Mailing Address - Street 2:A
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1310
Mailing Address - Country:US
Mailing Address - Phone:410-626-1040
Mailing Address - Fax:410-626-1060
Practice Address - Street 1:104 ANNAPOLIS ST
Practice Address - Street 2:A
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1310
Practice Address - Country:US
Practice Address - Phone:410-626-1040
Practice Address - Fax:410-626-1060
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGL13OtherBCBS MARYLAND PIN
MDB952OtherBCBS FEDERAL PIN
MDG113OtherBCBS GL13 CONFUSION