Provider Demographics
NPI:1881789501
Name:ADLER, MARIANNA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:ADLER
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 1:1500 WEST 38TH ST., SUITE 49
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-6301
Mailing Address - Country:US
Mailing Address - Phone:512-453-9225
Mailing Address - Fax:512-453-7899
Practice Address - Street 1:1500 WEST 38TH ST., SUITE 49
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-6301
Practice Address - Country:US
Practice Address - Phone:512-453-9225
Practice Address - Fax:512-453-7899
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30849103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00783EMedicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD
TXS98700Medicare UPIN