Provider Demographics
NPI:1275801540
Name:SURIANO, MARISSA NANCY (MA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:NANCY
Last Name:SURIANO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 W 15TH ST
Mailing Address - Street 2:APARTMENT 11
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-5944
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:312 W 15TH ST
Practice Address - Street 2:APARTMENT 11
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5944
Practice Address - Country:US
Practice Address - Phone:201-248-2365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health