Provider Demographics
NPI:1558462549
Name:MARINO, ROCCO ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROCCO
Middle Name:ANTHONY
Last Name:MARINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:STARBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01566
Mailing Address - Country:US
Mailing Address - Phone:508-347-5638
Mailing Address - Fax:508-347-7376
Practice Address - Street 1:450 MAIN ST
Practice Address - Street 2:
Practice Address - City:STARBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566
Practice Address - Country:US
Practice Address - Phone:508-347-7755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4222103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014040OtherBEACON
1014040OtherBEACON