Provider Demographics
NPI:1356791867
Name:MARINO, JEANIE
Entity type:Individual
Prefix:DR
First Name:JEANIE
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 1:1445 QUAKER ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01534-1326
Mailing Address - Country:US
Mailing Address - Phone:772-276-9004
Mailing Address - Fax:
Practice Address - Street 1:221 E MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2825
Practice Address - Country:US
Practice Address - Phone:508-902-0080
Practice Address - Fax:508-902-0066
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-15
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1227991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical