Provider Demographics
NPI:1265145056
Name:MARINO, SAMANTHA AERIN (LP)
Entity type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:AERIN
Last Name:MARINO
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 PERRY HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-2173
Mailing Address - Country:US
Mailing Address - Phone:412-837-4062
Mailing Address - Fax:
Practice Address - Street 1:1017 PERRY HWY STE 5
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-2173
Practice Address - Country:US
Practice Address - Phone:412-837-4062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019785103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical