Provider Demographics
NPI:1578824520
Name:BITTAR, CLARISA M I (M S ED)
Entity Type:Individual
Prefix:MRS
First Name:CLARISA
Middle Name:M
Last Name:BITTAR
Suffix:I
Gender:F
Credentials:M S ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 W 193RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-7501
Mailing Address - Country:US
Mailing Address - Phone:917-723-6506
Mailing Address - Fax:
Practice Address - Street 1:233 W 193RD ST FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-7501
Practice Address - Country:US
Practice Address - Phone:917-723-6506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator