Organization
MARINA SUD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARINA SUD PSYD (OWNER)
(914) 475-7256
Entity
Organization
Contact information
Practice address
1834 GRESHAM RD, LOUISVILLE, KY 40205-2424
(914) 475-7256
Mailing address
1834 GRESHAM RD, LOUISVILLE, KY 40205-2424
(914) 475-7256
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
04/22/2020
Last updated
04/22/2020
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