Healthcare Provider Details

I. General information

NPI: 1477694529
Provider Name (Legal Business Name): PIA C. MARINANGELI PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1646 1ST AVE 12G
NEW YORK NY
10028-4629
US

IV. Provider business mailing address

10 E END AVE SUITE 1K
NEW YORK NY
10021-1106
US

V. Phone/Fax

Practice location:
  • Phone: 212-613-0062
  • Fax:
Mailing address:
  • Phone: 212-613-0062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberR043229-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: