Provider Demographics
NPI:1154345726
Name:MARZANO, TERRA F (LCSW)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:F
Last Name:MARZANO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:MANZANITA
Mailing Address - State:OR
Mailing Address - Zip Code:97130-0261
Mailing Address - Country:US
Mailing Address - Phone:503-522-1116
Mailing Address - Fax:
Practice Address - Street 1:11505 PINEWOOD LN
Practice Address - Street 2:
Practice Address - City:NEHALEM
Practice Address - State:OR
Practice Address - Zip Code:97131-9650
Practice Address - Country:US
Practice Address - Phone:503-522-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORA28531041C0700X, 1041C0700X
ORL64951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical