Healthcare Provider Details

I. General information

NPI: 1194649970
Provider Name (Legal Business Name): SOFIA MARIE MARINUCCI MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 MERRICK RD STE 7
MASSAPEQUA NY
11758-6000
US

IV. Provider business mailing address

11 GOELLER AVE
HUNTINGTON STATION NY
11746-3819
US

V. Phone/Fax

Practice location:
  • Phone: 631-371-3825
  • Fax:
Mailing address:
  • Phone: 631-371-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP144336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: