Provider Demographics
NPI:1457634354
Name:RISSENBERG, MARIAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:
Last Name:RISSENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009016103G00000X, 103TA0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent