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General NPI Number Information
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NPI Number | 1720311061
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Entity Type | Individual
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Provider Name | JOANNE AMALIA MARZULLO-MANEZ M.S.
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Gender | Female
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Dates
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Enumeration Date | 09/17/2009
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Last Update Date | 09/17/2009
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Provider Practice Location Address
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Address Line | 5225-46 ROUTE 347
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776
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Country | US
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Telephone | 631-928-4635
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Fax |
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Provider Business Mailing Address
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Address Line | 4 GARY PL
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City | SELDEN
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State | NY
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Zip | 11784-1509
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Country | US
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Telephone | 631-384-9773
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 004260
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License Number State | NY
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