Healthcare Provider Details

I. General information

NPI: 1861518367
Provider Name (Legal Business Name): LESLIE ANN MARRA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 BLOOMINGDALE RD
WHITE PLAINS NY
10605-1504
US

IV. Provider business mailing address

82 EDGEWOOD RD
OSSINING NY
10562-2710
US

V. Phone/Fax

Practice location:
  • Phone: 914-997-5762
  • Fax: 914-997-8635
Mailing address:
  • Phone: 914-941-4924
  • Fax: 914-997-8635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number400315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: