Provider Demographics
NPI:1720311061
Name:MARZULLO-MANEZ, JOANNE AMALIA (MS)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:AMALIA
Last Name:MARZULLO-MANEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:GIOVANNA
Other - Middle Name:AMALIA
Other - Last Name:MARZULLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4 GARY PL
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-1509
Mailing Address - Country:US
Mailing Address - Phone:631-384-9773
Mailing Address - Fax:
Practice Address - Street 1:5225-46 ROUTE 347
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-928-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004260101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health