Provider Demographics
NPI:1003936048
Name:JUSKA, MARYANN DIVINEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:DIVINEY
Last Name:JUSKA
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 1:120 E 56TH ST
Mailing Address - Street 2:#710
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3607
Mailing Address - Country:US
Mailing Address - Phone:212-486-8162
Mailing Address - Fax:212-486-8163
Practice Address - Street 1:120 E 56TH ST RM 710
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3662
Practice Address - Country:US
Practice Address - Phone:212-486-8162
Practice Address - Fax:212-486-8163
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011969103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV5H201Medicare ID - Type Unspecified