Provider Demographics
NPI:1831525260
Name:CLERISME, MARIE NICOLE
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:NICOLE
Last Name:CLERISME
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIE
Other - Middle Name:NICOLE
Other - Last Name:CLERISME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MHC
Mailing Address - Street 1:175 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1226
Mailing Address - Country:US
Mailing Address - Phone:516-997-5547
Mailing Address - Fax:
Practice Address - Street 1:17810 WEXFORD TER
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3050
Practice Address - Country:US
Practice Address - Phone:718-658-1123
Practice Address - Fax:718-658-4641
Is Sole Proprietor?:No
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP90679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health