Provider Demographics
NPI:1285066241
Name:LAND, MARIE
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:LAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 SHELLERS BND APT 20
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-2795
Mailing Address - Country:US
Mailing Address - Phone:617-304-7261
Mailing Address - Fax:
Practice Address - Street 1:3181 SHELLERS BND
Practice Address - Street 2:APT. 20
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-2795
Practice Address - Country:US
Practice Address - Phone:617-304-7261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling