MEDICARE: BRIELLE MARINO M.A.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1841645561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIELLE MARINO M.A.

Provider Business Mailing Address
First Line	:	154 WASHINGTON PL
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1222
Country	:	US
Telephone Number	:	201-952-4544
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 WASHINGTON PL
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1222
Country	:	US
Telephone Number	:	201-952-4544
Fax Number	:

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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Directions to “ BRIELLE MARINO M.A.” Practice Location

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