Provider Demographics
NPI:1225239668
Name:MANCUSO, DANA JEAN (RPA-C, MFT)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:JEAN
Last Name:MANCUSO
Suffix:
Gender:F
Credentials:RPA-C, MFT
Other - Prefix:MS
Other - First Name:DANA
Other - Middle Name:JEAN
Other - Last Name:ATTANASIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPA-C
Mailing Address - Street 1:3771 NESCONSET HWY
Mailing Address - Street 2:STE 214
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1163
Mailing Address - Country:US
Mailing Address - Phone:631-751-1420
Mailing Address - Fax:631-509-0601
Practice Address - Street 1:3771 NESCONSET HWY
Practice Address - Street 2:STE 214
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1163
Practice Address - Country:US
Practice Address - Phone:631-751-1420
Practice Address - Fax:631-509-0601
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant