Provider Demographics
NPI:1497295216
Name:PADGETT, MARISA CHRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CHRISTINA
Last Name:PADGETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:CHRISTINA
Other - Last Name:MARINACCIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:480 OLD WESTBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-626-1971
Mailing Address - Fax:516-626-8043
Practice Address - Street 1:480 OLD WESTBURY ROAD
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-626-1971
Practice Address - Fax:516-626-8043
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099826104100000X
NY0932311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker