Provider Demographics
NPI:1598038259
Name:BARRA, MARISA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:BARRA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 JUNCTION BLVD.
Mailing Address - Street 2:ROOM 1525
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:718-760-7665
Mailing Address - Fax:718-760-7589
Practice Address - Street 1:5917 JUNCTION BLVD.
Practice Address - Street 2:ROOM 1525
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:718-760-7665
Practice Address - Fax:718-760-7589
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical