Provider Demographics
NPI:1861485583
Name:GESKIE, MARY ANNE HANLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANNE
Middle Name:HANLEY
Last Name:GESKIE
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 1:7 SALTMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11705-2205
Mailing Address - Country:US
Mailing Address - Phone:631-472-6048
Mailing Address - Fax:631-472-1817
Practice Address - Street 1:500 MONTAUK HWY
Practice Address - Street 2:SUITE Z
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4418
Practice Address - Country:US
Practice Address - Phone:631-422-5952
Practice Address - Fax:631-472-1817
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008795103TA0700X, 103TB0200X, 103TC0700X, 103TC2200X, 103TP0814X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02145393Medicaid
NY0048459OtherVALUE OPTIONS ID NUMBER
NYV50631Medicare ID - Type Unspecified