Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 099211-1 | NY |
NPI | 1003304957 |
---|---|
Provider Name | Mary Dorothy Marino |
First Address | Scotia, NY 12302-2026 |
Second Address | Albany, NY 12206-1242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2018 |
Last Update Date | 26/04/2018 |