MEDICARE: MARIANNA CHRYSILIOU CASAC2

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	42115	NY

General Provider Information

NPI Number	:	1902749740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANNA CHRYSILIOU CASAC2

Provider Business Mailing Address
First Line	:	4509 25TH AVE APT 2
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11103-1015
Country	:	US
Telephone Number	:	718-858-9658
Fax Number	:	718-858-9670

Provider Business Practice Location Address
First Line	:	25 CHAPEL ST FL 7
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1954
Country	:	US
Telephone Number	:	718-858-9658
Fax Number	:	718-858-9670

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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