Provider Demographics
NPI:1912391194
Name:MARINCO, KRISTI LAUREN
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:LAUREN
Last Name:MARINCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MIDVALE RD
Mailing Address - Street 2:1G
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1353
Mailing Address - Country:US
Mailing Address - Phone:551-206-1378
Mailing Address - Fax:
Practice Address - Street 1:36 MIDVALE RD
Practice Address - Street 2:1G
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1353
Practice Address - Country:US
Practice Address - Phone:551-206-1378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37F100177500106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist