Healthcare Provider Details

I. General information

NPI: 1154176840
Provider Name (Legal Business Name): PERRYN MARESCA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 STATE ROUTE 17M STE 4
MONROE NY
10950-3444
US

IV. Provider business mailing address

1977 VIA FIRENZE
HENDERSON NV
89044-0256
US

V. Phone/Fax

Practice location:
  • Phone: 845-547-0479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number108600
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: