Provider Demographics
NPI:1275814055
Name:MARIAN RISSENBERG, PH.D., NEUROPSYCHOLOGIST, PLLC
Entity Type:Organization
Organization Name:MARIAN RISSENBERG, PH.D., NEUROPSYCHOLOGIST, PLLC
Other - Org Name:THE CENTER FOR NEUROPSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-232-6245
Mailing Address - Street 1:125 KATONAH AVE
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-2136
Mailing Address - Country:US
Mailing Address - Phone:914-232-6245
Mailing Address - Fax:914-232-6245
Practice Address - Street 1:125 KATONAH AVE
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-2136
Practice Address - Country:US
Practice Address - Phone:914-232-6245
Practice Address - Fax:914-232-6245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009016103G00000X, 103TA0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty