Healthcare Provider Details

I. General information

NPI: 1740507995
Provider Name (Legal Business Name): MARIVEILA TOSADO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 OLD ORANGEBURG RD
ORANGEBURG NY
10962-1157
US

IV. Provider business mailing address

140 OLD ORANGEBURG RD
ORANGEBURG NY
10962-1157
US

V. Phone/Fax

Practice location:
  • Phone: 845-359-1000
  • Fax: 845-680-5580
Mailing address:
  • Phone: 845-359-1000
  • Fax: 845-680-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number017095
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: