Provider Demographics
NPI:1154050854
Name:ANTONINO DIMARE, CARINA (MS)
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:
Last Name:ANTONINO DIMARE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7035
Mailing Address - Country:US
Mailing Address - Phone:413-374-3921
Mailing Address - Fax:
Practice Address - Street 1:1009 FALLS RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7035
Practice Address - Country:US
Practice Address - Phone:413-374-3921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134621101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health