Provider Demographics
NPI:1699103150
Name:DEVITO, MARINA (MS)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:DEVITO
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 1:42 CONNELLY RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3030
Mailing Address - Country:US
Mailing Address - Phone:631-806-8114
Mailing Address - Fax:
Practice Address - Street 1:42 CONNELLY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3030
Practice Address - Country:US
Practice Address - Phone:631-806-8114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-21
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency