Provider Demographics
NPI:1023135589
Name:MARINO, NINA JANE
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:JANE
Last Name:MARINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SEAVIEW AVE
Mailing Address - Street 2:3H
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-2301
Mailing Address - Country:US
Mailing Address - Phone:203-644-2832
Mailing Address - Fax:203-855-9087
Practice Address - Street 1:2 OLMSTEAD PL
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06855-1318
Practice Address - Country:US
Practice Address - Phone:203-644-2832
Practice Address - Fax:203-855-9087
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0038881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002774Medicare ID - Type Unspecified