Provider Demographics
NPI:1417587197
Name:BIRD-DRASBY, MARILYN A
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:A
Last Name:BIRD-DRASBY
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 1:60 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-2233
Mailing Address - Country:US
Mailing Address - Phone:516-406-1315
Mailing Address - Fax:
Practice Address - Street 1:60 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-2233
Practice Address - Country:US
Practice Address - Phone:516-406-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty