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Individual
KATHLEEN MARINO
Active
Individual
KATHLEEN MARINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
PR057655-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00688179
RIVERHEAD MH MEDICAID PROVIDER
NY
01
—
10410C0700X
TAXONOMY # FOR SOCIAL WORKER
NY
01
—
1104920313
RIVERHEAD MH NPI
NY
01
—
116000464
SUFFOLK COUNTY TAX ID
NY
Enumeration date
11/19/2008
Last updated
11/19/2008
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