1346495215 NPI number — KATHLEEN MARINO L.C.S.W.

Table of content: KATHLEEN MARINO L.C.S.W. (NPI 1346495215)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346495215 NPI number — KATHLEEN MARINO L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARINO
Provider First Name:
KATHLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346495215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 CENTER DR
Provider Second Line Business Mailing Address:
RIVERHEAD MENTAL HEALTH CLINIC, SECOND FLOOR
Provider Business Mailing Address City Name:
RIVERHEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11901-3393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-852-1440
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CENTER DR
Provider Second Line Business Practice Location Address:
RIVERHEAD MENTAL HEALTH CLINIC, SECOND FLOOR
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901-3393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-852-1440
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  PR057655-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10410C0700X . This is a "TAXONOMY # FOR SOCIAL WORKER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1104920313 . This is a "RIVERHEAD MH NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00688179 . This is a "RIVERHEAD MH MEDICAID PROVIDER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 116000464 . This is a "SUFFOLK COUNTY TAX ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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