Provider Demographics
NPI:1407274640
Name:MARINO, ELLEN L (LMFT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:L
Last Name:MARINO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 NINTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116
Mailing Address - Country:US
Mailing Address - Phone:415-564-3936
Mailing Address - Fax:415-564-3936
Practice Address - Street 1:55 NEW MONTGOMERY ST
Practice Address - Street 2:SUITE 303
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3412
Practice Address - Country:US
Practice Address - Phone:415-564-3936
Practice Address - Fax:415-564-3936
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT78393106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist