Provider Demographics
NPI:1053408518
Name:FINO, MARTIN JAMES (PHD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JAMES
Last Name:FINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701-4046
Mailing Address - Country:US
Mailing Address - Phone:802-775-3600
Mailing Address - Fax:802-775-2954
Practice Address - Street 1:73 CENTER ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4046
Practice Address - Country:US
Practice Address - Phone:802-775-3600
Practice Address - Fax:802-775-2954
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048-0000760103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2449Medicaid
VTFI VN2449Medicare ID - Type Unspecified