Doctor Name: | ANTHONY MICHAEL MARINO |
NPI Number: | 1063451623 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LICSW |
License Number: | ISW00290 |
Business Practice Address: | 1070 Main St Pawtucket, RI - 028604847 |
Business Phone Number: | 4017276400 |
Business Fax Number: | |
Mailing Address: | 1020 Park Ave, Suite 216 CRANSTON |
State: | RI |
Postal Code: | 029103227 |
Phone Number: | 4019449659 |
Fax Number: | 4019449859 |
NPI Enumeration Date: | 06/06/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ISW00290 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | RI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |