Provider Demographics
NPI:1235672718
Name:MARCANO, EDRIENE
Entity Type:Individual
Prefix:
First Name:EDRIENE
Middle Name:
Last Name:MARCANO
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 1:51 SCARBOROUGH LN STE D
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5173
Mailing Address - Country:US
Mailing Address - Phone:845-632-1254
Mailing Address - Fax:
Practice Address - Street 1:538 BROADHOLLOW RD STE 202
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3668
Practice Address - Country:US
Practice Address - Phone:631-385-7780
Practice Address - Fax:646-839-5781
Is Sole Proprietor?:No
Enumeration Date:2016-11-30
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician