Provider Demographics
NPI:1932172616
Name:PAPPO, MARICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARICE
Middle Name:
Last Name:PAPPO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1241
Mailing Address - Country:US
Mailing Address - Phone:518-798-1159
Mailing Address - Fax:518-792-1970
Practice Address - Street 1:55 WILLOW RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1241
Practice Address - Country:US
Practice Address - Phone:518-798-1159
Practice Address - Fax:518-792-1970
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-11
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 004500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01449921Medicaid
NY004500OtherNYS PSYCHOLOGY LICENSE
NY004500OtherNYS PSYCHOLOGY LICENSE