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General NPI Number Information
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NPI Number | 1255816708
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Entity Type | Individual
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Provider Name | CAROLINE VIEIRA MARINO
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Gender | Female
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 03/08/2024
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Provider Practice Location Address
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Address Line | 112 9TH AVE S STE B4
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City | NAMPA
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State | ID
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Zip | 83651-3825
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Country | US
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Telephone | 208-261-1076
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Fax | 208-586-5120
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Provider Business Mailing Address
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Address Line | 2872 S PINE FLATS WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-9140
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Country | US
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Telephone | 310-210-1664
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-6977
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCPC-10031
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License Number State | ID
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