Healthcare Provider Details

I. General information

NPI: 1508064767
Provider Name (Legal Business Name): PATRICE A. LA MARIANA LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 5TH AVE SUITE 1205B
NEW YORK NY
10011-8002
US

IV. Provider business mailing address

80 5TH AVE SUITE 1205B
NEW YORK NY
10011-8002
US

V. Phone/Fax

Practice location:
  • Phone: 917-887-7745
  • Fax: 212-989-1758
Mailing address:
  • Phone: 917-887-7745
  • Fax: 212-989-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000016-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: