Provider Demographics
NPI:1881053536
Name:MARINO, SAMANTHA (MS CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1R NEWBURY ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-3816
Mailing Address - Country:US
Mailing Address - Phone:978-535-3355
Mailing Address - Fax:
Practice Address - Street 1:1R NEWBURY ST
Practice Address - Street 2:SUITE 303
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4065
Practice Address - Country:US
Practice Address - Phone:978-535-3355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-8913235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist