Provider Demographics
NPI:1841482312
Name:MARINO, MICHELLE FRANCES (SLP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:FRANCES
Last Name:MARINO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BELKNAP ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2304
Mailing Address - Country:US
Mailing Address - Phone:781-392-4073
Mailing Address - Fax:
Practice Address - Street 1:144 BELKNAP ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2304
Practice Address - Country:US
Practice Address - Phone:781-392-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist