Provider Demographics
NPI:1003463720
Name:MARINO, JENNIFER (LMHCA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5817
Mailing Address - Country:US
Mailing Address - Phone:206-203-7399
Mailing Address - Fax:
Practice Address - Street 1:108 S JACKSON ST STE 203
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2883
Practice Address - Country:US
Practice Address - Phone:206-203-7399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2021-02-10
Deactivation Date:2020-12-20
Deactivation Code:
Reactivation Date:2021-02-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program