Healthcare Provider Details

I. General information

NPI: 1275814055
Provider Name (Legal Business Name): MARIAN RISSENBERG, PH.D., NEUROPSYCHOLOGIST, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 KATONAH AVE
KATONAH NY
10536-2136
US

IV. Provider business mailing address

125 KATONAH AVE
KATONAH NY
10536-2136
US

V. Phone/Fax

Practice location:
  • Phone: 914-232-6245
  • Fax: 914-232-6245
Mailing address:
  • Phone: 914-232-6245
  • Fax: 914-232-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number009016
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number009016
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number009016
License Number StateNY

VIII. Authorized Official

Name: DR. MARIAN RISSENBERG
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 914-232-6245