Provider Demographics
NPI:1811652837
Name:MARIANO, BROOKE PAIGE (LSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:PAIGE
Last Name:MARIANO
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:PAIGE
Other - Last Name:DECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:228 S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-2545
Mailing Address - Country:US
Mailing Address - Phone:570-904-7363
Mailing Address - Fax:570-227-1591
Practice Address - Street 1:228 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-2545
Practice Address - Country:US
Practice Address - Phone:570-904-7363
Practice Address - Fax:570-227-1591
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02997780Medicaid