Provider Demographics
NPI:1891040085
Name:DELLICURTI, MARISA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:
Last Name:DELLICURTI
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 HAWK LANE
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2109
Mailing Address - Country:US
Mailing Address - Phone:631-265-5856
Mailing Address - Fax:
Practice Address - Street 1:4 HAWK LN
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2207
Practice Address - Country:US
Practice Address - Phone:631-265-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY518865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist