Healthcare Provider Details

I. General information

NPI: 1184412090
Provider Name (Legal Business Name): ALLIE MARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WYMORE RD
WINTER PARK FL
32789-2822
US

IV. Provider business mailing address

8 ZEPPO CT
PALM COAST FL
32164-5234
US

V. Phone/Fax

Practice location:
  • Phone: 727-495-6609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: