Provider Demographics
NPI:1285780445
Name:MORAN, MARIANNE JEANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:JEANNE
Last Name:MORAN
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:CMR 467 BOX 218
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09096
Mailing Address - Country:DE
Mailing Address - Phone:611-716-4258
Mailing Address - Fax:
Practice Address - Street 1:WAAF CLINIC
Practice Address - Street 2:UNIT 29623
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09096
Practice Address - Country:DE
Practice Address - Phone:613-455-6104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03320103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic