Provider Demographics
NPI:1760541940
Name:TERZAGHI, MARI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARI
Middle Name:
Last Name:TERZAGHI
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 1:165 W 46TH ST
Mailing Address - Street 2:SUITE 1211-A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-2515
Mailing Address - Country:US
Mailing Address - Phone:212-819-1214
Mailing Address - Fax:212-722-8118
Practice Address - Street 1:165 W 46TH ST
Practice Address - Street 2:SUITE 1211-A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-2501
Practice Address - Country:US
Practice Address - Phone:212-819-1214
Practice Address - Fax:212-722-8118
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007449-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV66041Medicare ID - Type Unspecified