Provider Demographics
NPI:1497269286
Name:GOMEZ SCHURSKY, MARISSA M (LMFT)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:M
Last Name:GOMEZ SCHURSKY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 29TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2567
Mailing Address - Country:US
Mailing Address - Phone:516-241-9083
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 304
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8154
Practice Address - Country:US
Practice Address - Phone:516-241-9083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001450106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist