Provider Demographics
NPI:1649625823
Name:MARINO, SARA RIAN (LMSW, LMFT)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:RIAN
Last Name:MARINO
Suffix:
Gender:F
Credentials:LMSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20816 E 11 MILE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1579
Mailing Address - Country:US
Mailing Address - Phone:586-556-1516
Mailing Address - Fax:
Practice Address - Street 1:20816 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1565
Practice Address - Country:US
Practice Address - Phone:586-556-1516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-26
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
4101006682106H00000X
MI68010983531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1336610393Medicaid