MEDICARE: MARIEL BUQUE PH.D. PSYCHOLOGY PLLC

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1407705510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIEL BUQUE PH.D. PSYCHOLOGY PLLC

Provider Business Mailing Address
First Line	:	442 LORIMER ST STE D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-1030
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 LEXINGTON AVE
Second Line	:
City	:	BLOOMFIELD
State	:	NJ
Zip	:	07003-5715
Country	:	US
Telephone Number	:	407-212-7768
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIEL BUQUE
Credential	:	PH.D.
Telephone Number	:	973-519-5033

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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