Provider Demographics
NPI:1063708451
Name:MARUYAMA, BRIAN ADAM (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ADAM
Last Name:MARUYAMA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 SENTINEL CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-0677
Mailing Address - Country:US
Mailing Address - Phone:209-631-6572
Mailing Address - Fax:
Practice Address - Street 1:1168 SENTINEL CT
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0677
Practice Address - Country:US
Practice Address - Phone:209-631-6572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA32647103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health