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General NPI Number Information
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NPI Number | 1811970791
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Entity Type | Individual
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Provider Name | MARINA B LUNG M.A.
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Gender | Female
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 6800 W CENTRAL AVE #D-2
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City | TOLEDO
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State | OH
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Zip | 43617-1135
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Country | US
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Telephone | 419-841-2298
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Fax | 419-841-7245
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Provider Business Mailing Address
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Address Line | 6800 W CENTRAL AVE #D-2
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City | TOLEDO
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State | OH
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Zip | 43617-1135
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Country | US
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Telephone | 419-841-2298
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Fax | 419-841-7245
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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 | 2692
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License Number State | OH
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