Provider Demographics
NPI:1164792818
Name:NEPTUNE, MARIE L (NURSE PRACT PSYCH)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:L
Last Name:NEPTUNE
Suffix:
Gender:F
Credentials:NURSE PRACT PSYCH
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:L
Other - Last Name:NEPTUNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NPP
Mailing Address - Street 1:998 CROOKED HILL RD
Mailing Address - Street 2:WESTERN SUFFOLK CENTER
Mailing Address - City:WEST BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1019
Mailing Address - Country:US
Mailing Address - Phone:631-761-2082
Mailing Address - Fax:631-761-2282
Practice Address - Street 1:998 CROOKED HILL RD
Practice Address - Street 2:WESTERN SUFFOLK CENTER
Practice Address - City:WEST BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1019
Practice Address - Country:US
Practice Address - Phone:631-761-2082
Practice Address - Fax:631-761-2282
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY549429163WP0808X
NYF401550363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health