MEDICARE: MARYAN NASR MFT-LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	P117675	NY

General Provider Information

NPI Number	:	1184347874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYAN NASR MFT-LP

Provider Business Mailing Address
First Line	:	2294 E 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4640
Country	:	US
Telephone Number	:	347-620-3339
Fax Number	:

Provider Business Practice Location Address
First Line	:	2294 E 15TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4640
Country	:	US
Telephone Number	:	347-620-3339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	10/10/2024

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