Provider Demographics
NPI:1831554252
Name:MARIN-SOLER, IVAN
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:MARIN-SOLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9604 SUTHERLAND RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-3262
Mailing Address - Country:US
Mailing Address - Phone:202-631-0422
Mailing Address - Fax:
Practice Address - Street 1:9604 SUTHERLAND ROAD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901
Practice Address - Country:US
Practice Address - Phone:202-631-0422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical