Provider Demographics
NPI:1366037087
Name:CLARK MARINO, ADRIENNE (LPC)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:CLARK MARINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:MARINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:507 GREGG ST
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1333
Mailing Address - Country:US
Mailing Address - Phone:610-823-0116
Mailing Address - Fax:
Practice Address - Street 1:1105 BERKSHIRE BLVD OFC 110
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1248
Practice Address - Country:US
Practice Address - Phone:610-374-4963
Practice Address - Fax:610-378-5403
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH05521101YM0800X
PAPC018457101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health