Provider Demographics
NPI:1134268220
Name:MARINELLO, NEIL (PSY D)
Entity type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:MARINELLO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 MAXHAM MEADOW WAY
Mailing Address - Street 2:STE 1038
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091
Mailing Address - Country:US
Mailing Address - Phone:802-457-4233
Mailing Address - Fax:802-457-4261
Practice Address - Street 1:217 MAXHAM MEADOW WAY
Practice Address - Street 2:STE 1038
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091
Practice Address - Country:US
Practice Address - Phone:802-457-4233
Practice Address - Fax:802-457-4261
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000014103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0002855Medicaid
713823OtherMVP
0622855OtherBCBS
60345OtherCIGNA
0622855OtherBCBS