Provider Demographics
NPI:1750884854
Name:MARCIANO, JAE ELLEN (MA)
Entity type:Individual
Prefix:
First Name:JAE
Middle Name:ELLEN
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 SW 4TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-6406
Mailing Address - Country:US
Mailing Address - Phone:541-516-6330
Mailing Address - Fax:
Practice Address - Street 1:2659 SW 4TH ST STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-6406
Practice Address - Country:US
Practice Address - Phone:541-516-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health