Provider Demographics
NPI:1841645561
Name:MARINO, BRIELLE (MA)
Entity type:Individual
Prefix:
First Name:BRIELLE
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1222
Mailing Address - Country:US
Mailing Address - Phone:201-952-4544
Mailing Address - Fax:
Practice Address - Street 1:154 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1222
Practice Address - Country:US
Practice Address - Phone:201-952-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist