Healthcare Provider Details

I. General information

NPI: 1851413256
Provider Name (Legal Business Name): KATHERINE MARNUCCI N.Y.S. LICENSES PSYC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 EAST 96 STREET (APT 15K)
NEW YORK NY
10128
US

IV. Provider business mailing address

175 EAST 96 STREET (APT 15K)
NEW YORK NY
10128
US

V. Phone/Fax

Practice location:
  • Phone: 212-534-3332
  • Fax:
Mailing address:
  • Phone: 212-534-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number000085
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number098000102
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN1843534
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: