Individual
DR. DONNA M MARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
1101 LAKE ST, STE 310, OAK PARK, IL 60301-1085
(773) 882-0373
(708) 524-8758
Mailing address
1101 LAKE ST, STE 310, OAK PARK, IL 60301-1085
(773) 882-0373
(708) 524-8758
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071006816
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623882
BLUE CROSS BLUE SHIELD
IL
Enumeration date
08/22/2006
Last updated
11/02/2011
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