Provider Demographics
NPI:1144600545
Name:MARINO, ANA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 NE 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4770
Mailing Address - Country:US
Mailing Address - Phone:786-547-7907
Mailing Address - Fax:305-742-2190
Practice Address - Street 1:971 NE 4TH AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4770
Practice Address - Country:US
Practice Address - Phone:786-547-7907
Practice Address - Fax:305-742-2190
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No252Y00000XAgenciesEarly Intervention Provider Agency