Healthcare Provider Details

I. General information

NPI: 1861485583
Provider Name (Legal Business Name): MARY ANNE HANLEY GESKIE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2005
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MONTAUK HWY SUITE Z
WEST ISLIP NY
11795-4418
US

IV. Provider business mailing address

7 SALTMEADOW CT
BAYPORT NY
11705-2205
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-5952
  • Fax: 631-472-1817
Mailing address:
  • Phone: 631-472-6048
  • Fax: 631-472-1817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number008795
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number008795
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008795
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number008795
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number008795
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number008795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: