MEDICARE: MARINA GABRIELLE MARIE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	109879	TX

General Provider Information

NPI Number	:	1215898648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA GABRIELLE MARIE

Provider Business Mailing Address
First Line	:	1041 LAILA LN
Second Line	:
City	:	BELTON
State	:	TX
Zip	:	76513-1704
Country	:	US
Telephone Number	:	804-307-6440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 LAILA LN
Second Line	:
City	:	BELTON
State	:	TX
Zip	:	76513-1704
Country	:	US
Telephone Number	:	804-307-6440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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Directions to “ MARINA GABRIELLE MARIE ” Practice Location

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