Healthcare Provider Details

I. General information

NPI: 1245349893
Provider Name (Legal Business Name): DEBORAH JANETTE MARINO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEBBIE JANETTE MARINO LCSW

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 US HIGHWAY 380 STE 517
CROSSROADS TX
76227-2661
US

IV. Provider business mailing address

8700 US HIGHWAY 380 STE 517
CROSSROADS TX
76227-2661
US

V. Phone/Fax

Practice location:
  • Phone: 866-832-1708
  • Fax: 888-789-4391
Mailing address:
  • Phone: 866-832-1708
  • Fax: 888-789-4391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS23891
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: