Provider Demographics
NPI:1811067390
Name:SENE, MARITZA (CASAC)
Entity type:Individual
Prefix:MRS
First Name:MARITZA
Middle Name:
Last Name:SENE
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-3206
Mailing Address - Country:US
Mailing Address - Phone:212-348-4660
Mailing Address - Fax:212-348-5427
Practice Address - Street 1:2009 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-3208
Practice Address - Country:US
Practice Address - Phone:212-348-4660
Practice Address - Fax:212-348-5427
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11045101YA0400X
NY0703102213101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)