Provider Demographics
NPI:1578723854
Name:DEUTSCH, MARIEL BROOKE (MD, FAAN)
Entity Type:Individual
Prefix:DR
First Name:MARIEL
Middle Name:BROOKE
Last Name:DEUTSCH
Suffix:
Gender:F
Credentials:MD, FAAN
Other - Prefix:
Other - First Name:MARIEL
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1955 MERRICK RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4635
Mailing Address - Country:US
Mailing Address - Phone:516-636-3873
Mailing Address - Fax:516-210-2616
Practice Address - Street 1:1955 MERRICK RD STE 204
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4635
Practice Address - Country:US
Practice Address - Phone:516-636-3873
Practice Address - Fax:516-210-2616
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2641632084N0400X, 2084B0040X
390200000X
CAA1246592084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program