Provider Demographics
NPI:1881716272
Name:MARINUCCI, BENJAMIN M (MA, NCPSYA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:MARINUCCI
Suffix:
Gender:M
Credentials:MA, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 E. 96TH ST. (ISK)
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-289-4544
Mailing Address - Fax:
Practice Address - Street 1:175 E. 96TH ST. (ISK)
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-289-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000070102L00000X
VT098000101102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
000-070OtherN.Y.S. LICENSE PSYCHOANALIST