Doctor Name: | DIANE EE MARINO |
NPI Number: | 1134283898 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PFP |
License Number: | 3925 |
Business Practice Address: | 21278 E Avenida Del Valle Queen Creek, AZ - 852426919 |
Business Phone Number: | 4806418622 |
Business Fax Number: | 4803250177 |
Mailing Address: | 21278 E Avenida Del Valle, QUEEN CREEK |
State: | AZ |
Postal Code: | 852426919 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 3925 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |