Provider Demographics
NPI:1528575099
Name:MARTONE, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MARTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 PRAIRIE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-1103
Mailing Address - Country:US
Mailing Address - Phone:631-559-6744
Mailing Address - Fax:
Practice Address - Street 1:123 PRAIRIE DR
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-1103
Practice Address - Country:US
Practice Address - Phone:631-559-6744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst