Provider Demographics
NPI:1043051998
Name:MARIANO DYSON, DARLLY (LCSW)
Entity type:Individual
Prefix:
First Name:DARLLY
Middle Name:
Last Name:MARIANO DYSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DARLLY
Other - Middle Name:
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2021 GUADALUPE ST STE 260
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-5654
Mailing Address - Country:US
Mailing Address - Phone:646-941-7645
Mailing Address - Fax:929-596-7897
Practice Address - Street 1:2021 GUADALUPE ST STE 260
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-5654
Practice Address - Country:US
Practice Address - Phone:646-941-7645
Practice Address - Fax:929-596-7897
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1039461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical