Provider Demographics
NPI:1427381250
Name:CORSO, MARLAENA (PSYD)
Entity Type:Individual
Prefix:
First Name:MARLAENA
Middle Name:
Last Name:CORSO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5078
Mailing Address - Country:US
Mailing Address - Phone:631-512-2497
Mailing Address - Fax:631-512-2497
Practice Address - Street 1:555 BROADHOLLOW RD
Practice Address - Street 2:SUITE 202
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-5078
Practice Address - Country:US
Practice Address - Phone:631-512-2497
Practice Address - Fax:631-512-2497
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP70970103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist