Provider Demographics
NPI:1184347874
Name:NASR, MARYAN (MFT-LP)
Entity type:Individual
Prefix:
First Name:MARYAN
Middle Name:
Last Name:NASR
Suffix:
Gender:F
Credentials:MFT-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2294 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4640
Mailing Address - Country:US
Mailing Address - Phone:347-620-3339
Mailing Address - Fax:
Practice Address - Street 1:2294 E 15TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4640
Practice Address - Country:US
Practice Address - Phone:347-620-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP117675106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist