Provider Demographics
NPI:1235282641
Name:CARRESE, MARIE A
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:A
Last Name:CARRESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1912
Mailing Address - Country:US
Mailing Address - Phone:516-599-5905
Mailing Address - Fax:
Practice Address - Street 1:66 GATES AVE
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1912
Practice Address - Country:US
Practice Address - Phone:516-599-5905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012339103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY079588OtherVALUE OPTIONS
NY079588OtherVALUE OPTIONS