Provider Demographics
NPI:1326812074
Name:CARRIZO, MARCELO ENRIQUE
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:ENRIQUE
Last Name:CARRIZO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4127 67TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-8539
Mailing Address - Country:US
Mailing Address - Phone:347-636-8292
Mailing Address - Fax:
Practice Address - Street 1:4127 67TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-8539
Practice Address - Country:US
Practice Address - Phone:347-636-8292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral