Provider Demographics
NPI:1619319431
Name:DESRAVINES-JOSEPH, MARIE R
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:R
Last Name:DESRAVINES-JOSEPH
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 1:2037 UTICA AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-3215
Mailing Address - Country:US
Mailing Address - Phone:718-377-7757
Mailing Address - Fax:718-758-9497
Practice Address - Street 1:2037 UTICA AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-3215
Practice Address - Country:US
Practice Address - Phone:718-377-7757
Practice Address - Fax:718-758-9497
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator