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General NPI Number Information
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NPI Number | 1871471375
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Entity Type | Organization
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Legal Business Name | PATHWAYS TO POTENTIAL PSYCHOLOGY PLLC
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Dates
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Enumeration Date | 08/22/2025
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 275 9TH ST UNIT 111
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City | BROOKLYN
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State | NY
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Zip | 11215-4457
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Country | US
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Telephone | 646-801-5711
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Fax |
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Provider Business Mailing Address
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Address Line | 275 9TH ST UNIT 111
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City | BROOKLYN
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State | NY
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Zip | 11215-4457
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Country | US
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Telephone | 646-801-5711
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JON MARRELLI
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Credential | PSY.D
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Telephone | 646-801-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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