Healthcare Provider Details

I. General information

NPI: 1073531927
Provider Name (Legal Business Name): HOLLY MARINI APRN, LADC, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 BRIDGEPORT AVE
MILFORD CT
06460-3142
US

IV. Provider business mailing address

949 BRIDGEPORT AVE
MILFORD CT
06460-3142
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-6365
  • Fax:
Mailing address:
  • Phone: 203-878-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number001492
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000579
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR29021
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: