MEDICARE: DR. CHERYLYNN 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	103T00000X	Psychologist	022225-1

General Provider Information

NPI Number	:	1184141541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHERYLYNN MARINO PH.D.

Provider Business Mailing Address
First Line	:	134A BOYDEN AVE
Second Line	:
City	:	MAPLEWOOD
State	:	NJ
Zip	:	07040-1989
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-2400
Country	:	US
Telephone Number	:	646-456-4911
Fax Number	:

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

Provider Enumeration Date	:	08/26/2017
Last Update Date	:	07/02/2021

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