Provider Demographics
NPI:1912124173
Name:MARINO-CHUBB, SHARON JEAN (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JEAN
Last Name:MARINO-CHUBB
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:JEAN
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:231 CHUBB LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-8823
Mailing Address - Country:US
Mailing Address - Phone:406-892-2892
Mailing Address - Fax:406-892-2892
Practice Address - Street 1:231 CHUBB LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-8823
Practice Address - Country:US
Practice Address - Phone:406-892-2892
Practice Address - Fax:406-892-2892
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT559101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT559OtherLCPC LICENSE NUMBER
MT0253734Medicaid
36742OtherNBCC MEMBERSHIP
5123509OtherACA MEMBERSHIP
MT74415OtherBLUE CROSS PROVIDER NUMBE
273427826-8OtherHPSO INSURANCE