Provider Demographics
NPI:1003179367
Name:GESIARA-OCCHICONE, MAGDALENA (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:
Last Name:GESIARA-OCCHICONE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:MRS
Other - First Name:MAGDA
Other - Middle Name:
Other - Last Name:OCCHICONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:48 ELM ST.
Mailing Address - Street 2:
Mailing Address - City:ALLENDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07401-1509
Mailing Address - Country:US
Mailing Address - Phone:845-642-6697
Mailing Address - Fax:
Practice Address - Street 1:48 ELM ST.
Practice Address - Street 2:
Practice Address - City:ALLENDALE
Practice Address - State:NJ
Practice Address - Zip Code:07401-1509
Practice Address - Country:US
Practice Address - Phone:845-642-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI1001671106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist