Provider Demographics
NPI:1609020270
Name:MARINO, EILEEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E 201ST ST
Mailing Address - Street 2:APT. 1B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-1812
Mailing Address - Country:US
Mailing Address - Phone:718-365-3348
Mailing Address - Fax:
Practice Address - Street 1:215 E 201ST ST
Practice Address - Street 2:APT. 1B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1812
Practice Address - Country:US
Practice Address - Phone:718-365-3348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016769-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist