Provider Demographics
NPI:1437242542
Name:MARINO, DIANE P (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:P
Last Name:MARINO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1683 RTE 88 W
Mailing Address - Street 2:STE A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-840-5266
Mailing Address - Fax:732-840-7840
Practice Address - Street 1:1683 RTE 88 W
Practice Address - Street 2:STE A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-840-5266
Practice Address - Fax:732-840-7840
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051889001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical