Provider Demographics
NPI:1841623535
Name:TIANO, MARK ANTHONY
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTHONY
Last Name:TIANO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 CORK OAK WAY
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-2010
Mailing Address - Country:US
Mailing Address - Phone:209-693-7037
Mailing Address - Fax:
Practice Address - Street 1:326 CORK OAK WAY
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-2010
Practice Address - Country:US
Practice Address - Phone:209-693-7037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW884421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical