Basic Information
| Provider Information | |||||||||
| NPI: | 1821586264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARINO | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 ROYAL PARK DR APT 1B | ||||||||
| Address2: | |||||||||
| City: | OAKLAND PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333095866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176702696 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7481 W OAKLAND PARK BLVD STE 100 | ||||||||
| Address2: | |||||||||
| City: | TAMARAC | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333194985 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547717743 | ||||||||
| FaxNumber: | 9547717748 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2018 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | SW11152 | FL | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | R050690-1 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | SW11152 | FL | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.