Provider Demographics
NPI:1033132659
Name:MARINOFF, AMBER NICOLE (MA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICOLE
Last Name:MARINOFF
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 OLEANDER ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5240
Mailing Address - Country:US
Mailing Address - Phone:714-255-9320
Mailing Address - Fax:
Practice Address - Street 1:1633 E 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-5163
Practice Address - Country:US
Practice Address - Phone:714-565-2830
Practice Address - Fax:714-565-2833
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46265101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health