Provider Demographics
NPI:1548950587
Name:MARINO, ALYSSA JEANNE
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:JEANNE
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 1:509 11TH ST APT 2004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1640
Mailing Address - Country:US
Mailing Address - Phone:678-332-7127
Mailing Address - Fax:
Practice Address - Street 1:8930 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4713
Practice Address - Country:US
Practice Address - Phone:865-407-2083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician