Provider Demographics
NPI:1033349527
Name:MARINO, SARAH ROSE MANTELL (LAC)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:ROSE MANTELL
Last Name:MARINO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 W NORTH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1530
Mailing Address - Country:US
Mailing Address - Phone:315-945-1659
Mailing Address - Fax:315-790-6582
Practice Address - Street 1:273 W NORTH ST STE 1
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1530
Practice Address - Country:US
Practice Address - Phone:315-719-7072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-20
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004119171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist