Healthcare Provider Details

I. General information

NPI: 1588519490
Provider Name (Legal Business Name): ANDREANA MARINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 DIVEN ST APT 5
PEEKSKILL NY
10566-2729
US

IV. Provider business mailing address

943 DIVEN ST APT 5
PEEKSKILL NY
10566-2729
US

V. Phone/Fax

Practice location:
  • Phone: 914-734-5254
  • Fax:
Mailing address:
  • Phone: 914-406-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: