MEDICARE: CANDACE NICOLE 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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1942777438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE NICOLE MARINO

Provider Business Mailing Address
First Line	:	9419 75TH ST
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-1005
Country	:	US
Telephone Number	:	917-349-5554
Fax Number	:

Provider Business Practice Location Address
First Line	:	9419 75TH ST
Second Line	:
City	:	OZONE PARK
State	:	NY
Zip	:	11416-1005
Country	:	US
Telephone Number	:	917-349-5554
Fax Number	:

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

Provider Enumeration Date	:	11/01/2018
Last Update Date	:	11/01/2018

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Directions to “ CANDACE NICOLE MARINO ” Practice Location

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