Provider Demographics
NPI:1902492028
Name:MARINO, VICTORIA (MS)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 OLD SAWMILL DR
Mailing Address - Street 2:
Mailing Address - City:BEACON FALLS
Mailing Address - State:CT
Mailing Address - Zip Code:06403-1253
Mailing Address - Country:US
Mailing Address - Phone:203-571-9890
Mailing Address - Fax:
Practice Address - Street 1:519 HERITAGE RD STE 1E
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-1699
Practice Address - Country:US
Practice Address - Phone:475-239-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006235235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist