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General NPI Number Information
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NPI Number | 1174387989
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Entity Type | Individual
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Provider Name | CHRISTIANO MARCEL MARCELLO PEER SPECIALIST
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Gender | Male
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Dates
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Enumeration Date | 02/12/2024
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Last Update Date | 02/12/2024
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Provider Practice Location Address
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Address Line | 718 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3502
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Country | US
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Telephone | 646-732-8105
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Fax |
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Provider Business Mailing Address
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Address Line | 8 COUNTISBURY AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-1748
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Country | US
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Telephone | 646-732-8105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 0195
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License Number State | NY
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