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General NPI Number Information
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NPI Number | 1215030093
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Entity Type | Individual
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Provider Name | MICHAEL F. MARINO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 07/16/2007
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Provider Practice Location Address
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Address Line | 1305 MIDDLE COUNTRY RD SUITE 7
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City | SELDEN
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State | NY
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Zip | 11784-2554
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Country | US
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Telephone | 631-220-9285
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 MIDDLE COUNTRY RD SUITE 7
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City | SELDEN
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State | NY
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Zip | 11784-2554
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Country | US
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Telephone | 631-220-9285
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 008329
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License Number State | NY
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