Healthcare Provider Details

I. General information

NPI: 1396607818
Provider Name (Legal Business Name): MARIAN OWUSU AGYEMAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

274 MADISON AVE RM 1501
NEW YORK NY
10016-0701
US

IV. Provider business mailing address

10 MAYWOOD CT
FAIR LAWN NJ
07410-4107
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-1773
  • Fax:
Mailing address:
  • Phone: 347-343-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF408762-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NJ00869700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: