Provider Demographics
NPI:1184412090
Name:MARINO, ALLIE
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:
Last Name:MARINO
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 1:350 JERICHO TPKE STE 103
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1317
Mailing Address - Country:US
Mailing Address - Phone:516-399-5373
Mailing Address - Fax:
Practice Address - Street 1:350 JERICHO TPKE STE 103
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1317
Practice Address - Country:US
Practice Address - Phone:516-399-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP134837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health