Provider Demographics
NPI:1699023903
Name:GOLOVKO, MARINA LEONIDOVNA
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:LEONIDOVNA
Last Name:GOLOVKO
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARINA
Other - Middle Name:LEONIDOVNA
Other - Last Name:GOLOVKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SPECIAL EDUCATOR
Mailing Address - Street 1:711D SEAGIRT AVE APT 7E
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5763
Mailing Address - Country:US
Mailing Address - Phone:646-643-8613
Mailing Address - Fax:
Practice Address - Street 1:711D SEAGIRT AVE APT 7E
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-5763
Practice Address - Country:US
Practice Address - Phone:646-643-8613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist