MEDICARE: DR. JOANNA MARIE MARINO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810004487	VA
2	103TC0700X	Clinical Psychologist	PSY1000770	DC

General Provider Information

NPI Number	:	1144596958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNA MARIE MARINO PH.D.

Provider Business Mailing Address
First Line	:	2001 JEFFERSON DAVIS HWY
Second Line	:	SUITE 211
City	:	ARLINGTON
State	:	VA
Zip	:	22202-3603
Country	:	US
Telephone Number	:	571-257-3378
Fax Number	:	571-257-0906

Provider Business Practice Location Address
First Line	:	2001 JEFFERSON DAVIS HWY
Second Line	:	SUITE 211
City	:	ARLINGTON
State	:	VA
Zip	:	22202-3603
Country	:	US
Telephone Number	:	571-257-3378
Fax Number	:	571-257-0906

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2012
Last Update Date	:	03/26/2012

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