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General NPI Number Information
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NPI Number | 1861493629
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Entity Type | Individual
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Provider Name | WILLIAM MARRIN PHD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 05/05/2011
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Provider Practice Location Address
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Address Line | 200 BELLE TERRE RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-1928
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Country | US
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Telephone | 631-474-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 8 MANOR RD
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City | SMITHTOWN
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State | NY
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Zip | 11787-2715
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Country | US
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Telephone | 631-265-4670
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 008777
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License Number State | NY
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