Provider Demographics
NPI:1245909415
Name:MARSELLA, GIAN
Entity type:Individual
Prefix:
First Name:GIAN
Middle Name:
Last Name:MARSELLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:GIAN
Other - Middle Name:
Other - Last Name:MARSELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CASAC T
Mailing Address - Street 1:2264 AMSTERDAM AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2410
Mailing Address - Country:US
Mailing Address - Phone:646-491-2696
Mailing Address - Fax:
Practice Address - Street 1:233 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4051
Practice Address - Country:US
Practice Address - Phone:212-431-6177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34815101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)