Provider Demographics
NPI:1518942911
Name:OPPEDISANO, MARIE TERESE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:TERESE
Last Name:OPPEDISANO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:TERESE
Other - Last Name:LIEBERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24 APPLEGREEN DR
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1203
Mailing Address - Country:US
Mailing Address - Phone:516-626-1341
Mailing Address - Fax:516-621-0948
Practice Address - Street 1:24 APPLEGREEN DR
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568-1203
Practice Address - Country:US
Practice Address - Phone:516-626-1341
Practice Address - Fax:516-621-0948
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6061103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC120780OtherVYTRA
NY00767 74OtherGHI
NY01734207Medicaid
NY01734207Medicaid
NC120780OtherVYTRA