Provider Demographics
NPI:1619394574
Name:MARIN, LEA (MD, MPH)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ICAHN SCHOOL OF MEDICINE DEPARTMENT OF PSYCHIATRY
Mailing Address - Street 2:ONE GUSTAVE L. LEVY PLACE BOX 1230
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6508
Mailing Address - Country:US
Mailing Address - Phone:212-659-8734
Mailing Address - Fax:
Practice Address - Street 1:ONE GUSTAVE L. LEVY PLACE BOX 1230
Practice Address - Street 2:ICAHN SCHOOL OF MEDICINE DEPARTMENT OF PSYCHIATRY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-659-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUNKNOWN2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry