Provider Demographics
NPI:1558885996
Name:MARIGLIANO, ELISABETH J (NPP)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:J
Last Name:MARIGLIANO
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE.
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1064
Mailing Address - Country:US
Mailing Address - Phone:518-841-7360
Mailing Address - Fax:
Practice Address - Street 1:8 NORTHAMPTON RD.
Practice Address - Street 2:CHILDREN'S MENTAL HEALTH OP CLINIC
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-3224
Practice Address - Country:US
Practice Address - Phone:518-843-7520
Practice Address - Fax:518-843-7537
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY402215363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner