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General NPI Number Information
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NPI Number | 1861712523
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Entity Type | Individual
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Provider Name | CHRIS S MARINICH LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 06/04/2010
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Last Update Date | 06/04/2010
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Provider Practice Location Address
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Address Line | 1100 E MAIN ST
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City | ENDICOTT
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State | NY
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Zip | 13760-5254
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Country | US
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Telephone | 607-757-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 1162 SAPPHIRE DR
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City | ENDICOTT
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State | NY
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Zip | 13760-7023
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R042516-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number | 554228941
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License Number State | NY
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