Provider Demographics
NPI:1386002103
Name:CARMINO, MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:CARMINO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:STAUBITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4 CLEMATIS CT
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1839
Mailing Address - Country:US
Mailing Address - Phone:631-384-0732
Mailing Address - Fax:631-721-4111
Practice Address - Street 1:22 SOUTHERN BLVD STE 109
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1086
Practice Address - Country:US
Practice Address - Phone:631-384-0732
Practice Address - Fax:631-721-4111
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2023-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health