Provider Demographics
NPI:1659387199
Name:MARINO, CASADI M (LCSW)
Entity Type:Individual
Prefix:
First Name:CASADI
Middle Name:M
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 1:714 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-1826
Mailing Address - Country:US
Mailing Address - Phone:503-490-5856
Mailing Address - Fax:907-313-1400
Practice Address - Street 1:714 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1826
Practice Address - Country:US
Practice Address - Phone:503-490-5856
Practice Address - Fax:907-313-1400
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL34481041C0700X
OR05-11-96U3101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ04731Medicare UPIN
OR117520Medicare ID - Type Unspecified