Provider Demographics
NPI:1265659379
Name:MARINO, ERIN JOAN (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:JOAN
Last Name:MARINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 MAIN ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3780
Mailing Address - Country:US
Mailing Address - Phone:203-988-8943
Mailing Address - Fax:
Practice Address - Street 1:1052 MAIN ST
Practice Address - Street 2:SUITE 18
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3780
Practice Address - Country:US
Practice Address - Phone:203-988-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid