Provider Demographics
NPI:1225223118
Name:BARTHELEMY, MARIE CLARISSE (LPN)
Entity Type:Individual
Prefix:
First Name:MARIE CLARISSE
Middle Name:
Last Name:BARTHELEMY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:43 LINCOLN AVENUE APARTEMENT 2 IN REAR
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-1547
Mailing Address - Country:US
Mailing Address - Phone:914-740-4719
Mailing Address - Fax:
Practice Address - Street 1:43 LINCOLN AVE
Practice Address - Street 2:APT 2 REAR
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-1547
Practice Address - Country:US
Practice Address - Phone:914-740-4719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1799761164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01038513Medicaid