Provider Demographics
NPI:1477662237
Name:MARINO FOUNDATION FOR INTEGRATIVE MEDICINE, INC.
Entity Type:Organization
Organization Name:MARINO FOUNDATION FOR INTEGRATIVE MEDICINE, INC.
Other - Org Name:THE MARINO CENTER FOR INTEGRATIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-661-6225
Mailing Address - Street 1:2500 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:617-661-6225
Mailing Address - Fax:617-492-2002
Practice Address - Street 1:2500 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140
Practice Address - Country:US
Practice Address - Phone:617-661-6225
Practice Address - Fax:617-492-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4804103T00000X, 104100000X, 111N00000X, 133V00000X, 163W00000X, 207Q00000X, 207R00000X, 207V00000X, 208100000X, 2084N0400X, 2084P0800X, 225100000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA805470AOtherTUFTS -PT
MA31805OtherFALLON
MA5716242OtherCIGNA
MA601647OtherTUFTS - OTHER
MA601647OtherTUFTS HEALTH PLAN
MAM17120OtherBCBS
MA2521043OtherAETNA
MA805636OtherTUFTS - CHIRO
MAM17120OtherBCBS