Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YM0800X | Mental Health Counselor | 008566 | NY |
NPI | 1003049891 |
---|---|
Provider Name | Miss Amy Mazzarisi |
First Address | Staten Island, NY 10308-1502 |
Second Address | Staten Island, NY 10301-2507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2009 |
Last Update Date | 11/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003049891 | (05) | FL |