Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 000606 | NY |
Y | 103TS0200X | School Psychologist | 434735101 | NY |
NPI | 1043567118 |
---|---|
Provider Name | Ms. Jacquelyn Anne Marinello |
First Address | Sayville, NY 11782-2512 |
Second Address | Massapequa, NY 11758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 07/01/2022 |