Provider Demographics
NPI:1720049075
Name:MARIN, PATRIA V (PHD)
Entity type:Individual
Prefix:
First Name:PATRIA
Middle Name:V
Last Name:MARIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WEST 13TH STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:646-633-2336
Mailing Address - Fax:212-560-0936
Practice Address - Street 1:25 E 183RD ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-1242
Practice Address - Country:US
Practice Address - Phone:718-839-8900
Practice Address - Fax:718-839-8989
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NY018028103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist