Healthcare Provider Details

I. General information

NPI: 1245165562
Provider Name (Legal Business Name): MARISSA DIACO PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 FIFTH AVE STE 109
PELHAM NY
10803-3708
US

IV. Provider business mailing address

139 W 74TH ST APT 4A
NEW YORK NY
10023-2271
US

V. Phone/Fax

Practice location:
  • Phone: 914-368-2995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number028063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: