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NPI Code Detail

MEDICARE: JORDYN MARINO

MEDICARE: JORDYN MARINO
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1861008120
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYN MARINO
Provider Business Mailing Address
First Line : 32 BRIARWOOD DR
Second Line :
City : SALEM
State : NH
Zip : 03079-1696
Country : US
Telephone Number : 603-401-3034
Fax Number :
Provider Business Practice Location Address
First Line : 155 WEST ST STE 7
Second Line :
City : WILMINGTON
State : MA
Zip : 01887-6010
Country : US
Telephone Number : 617-923-7575
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2020
Last Update Date : 09/21/2020

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Directions to “ JORDYN MARINO ” Practice Location

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