Provider Demographics
NPI:1386189025
Name:MARINO, DEBORAH SUSAN (MED)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:SUSAN
Last Name:MARINO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:SUSAN
Other - Last Name:STROPE/MAIDEN JOYCE/FORMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1830 BRANTLEY RD
Mailing Address - Street 2:BUILDING C UNIT 8
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3938
Mailing Address - Country:US
Mailing Address - Phone:239-850-5697
Mailing Address - Fax:
Practice Address - Street 1:1830 BRANTLEY RD
Practice Address - Street 2:BUILDING C UNIT 8
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3938
Practice Address - Country:US
Practice Address - Phone:239-850-5697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1219428101Y00000X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool