Provider Demographics
NPI:1063971489
Name:MARINO,, DIANE L (MT-BC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:L
Last Name:MARINO,
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 N BARNETT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-1104
Mailing Address - Country:US
Mailing Address - Phone:814-849-1918
Mailing Address - Fax:
Practice Address - Street 1:334 N BARNETT ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-1104
Practice Address - Country:US
Practice Address - Phone:814-849-1918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02090OtherCERTIFICATION BOARD FOR MUSIC THERAPISTS