Active NPI
Ethan Maryon
- Social Worker
- Bountiful, UT
National Provider Identifier
1720533664
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 1325 N Main St Ste 3
Bountiful, UT 84010-6090 - Phone
- (801) 380-3087
- NPI assigned
- Aug 21, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Primary | ||
| Social Worker | 104100000X | 10382606-3502 | UT |
Addresses
Primary practice location
1325 N Main St Ste 3
Bountiful, UT 84010-6090
Mailing address
1957 E Hubbard Ave
Salt Lake City, UT 84108-1303
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10382606-3502 | UT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471737600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521504000000",
"number": "1720533664",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1957 E HUBBARD AVE",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841081303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1325 N MAIN ST STE 3",
"city": "BOUNTIFUL",
"state": "UT",
"postal_code": "840106090",
"telephone_number": "801-380-3087"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARYON",
"first_name": "ETHAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-21",
"last_updated": "2018-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": null,
"license": null,
"primary": true
},
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "UT",
"license": "10382606-3502",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bountiful, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.